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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 ( O" Z`06 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org C� ( I D—�% <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />�. <br />,'`�> ? 2 I ='� Y, v,�,.� I ( � ,, L ��� , l,� 4�_�, �� � � � � �> <br />PROJECT ADDRESS � <br />� <br />Owner <br />Tenanl <br />r , �:-Z< �'I/'-7�1 <br />__ % � i _ <br />Mail Address <br />Mail Address <br />Cily <br />� <br />�ll. �.i�f.t� LnirZ. <br />SWIe/Zip Phone <br />� �<� -� �6-soc� <br />State/Zip <br />Phone <br />�! i � p <br />�'{ Na.�( �r [�I'� L � Y" i C_ '� J� (L> �� �'� �� i/iCil il'I' <� �I ���C�� ��Z`'• "Z%�'/�,7 <br />C-loClfiCal Con�raclor M11ail Address Cily State/Zip Phone <br />��� r I l C. -- %�' (: (�jt �!'� <br />�.1�� t_ t_. ��J <br />Slate License Number <br />� , <br />/`- -t ti/'''�cY� l-�+�"•. � <br />Proposed Use o( Buildin9 <br />Dascription o( Work lo �c Don¢ i' ,r,� �_ ,_ - <br />NOl'E: WIRING IN NON-DWELL�NGS IS REQUIRED TO <br />BE IN RACFWAYS, MC OR AC CABLE. <br />CI7Y OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />>� <br />? yC�(� <br />Contracl Price ol Work <br />Contacl Person (Plan Reviow) <br />1 hereby certity fhaf 1 have read and examined this applicafio�• and know fhe same to be Vuo and <br />co�recL All provisions o! laws and ordinences govem�ng this type o! work will be complafed <br />whether spcafied herein o� noL The �ranfing ol n permR does not presumo fo give oufhonty fo <br />violafe or cancel the provisions o/ any other stafe or loca/ law regulafing censhuction or the <br />peAormm�ce o/ construcfion. Thaf 1 arn aufhonzed Gy the o�rner oI fhis property fo pedonn fhe <br />work lor which application is made and 1 comply wifri tlie State Contracfors La�v 19.27 RCW and <br />296.200 WAC. <br />FEE <br />SiynaWre Dale �^ <br />� i I <br />! <br />