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ELECiRICAL PERM�T APPI.ICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />�325-257-8810 - FAX 425-257-8857 — www.everettwa.o�g <br />APPI.ICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CRFDIT CARDS ARE NOT ACCEPTED <br />I <br />',�► I (.� �Ev`�r�� Lu„� ��irci�h <br />i PROJECT ADDRESS �-1-'�" �I- <br />�}RTiSA�I��m�S IUI,��Ev'�rc�rtnl�U*��-�33 �✓c��N <br />CK�ne� Mail AUdress City <br />Tenant <br />J[' d01 7 r_/C( I <br />Electrical Conlractor <br />GEo�:c�s������ <br />State License Number <br />� . <br />K�����ri��i <br />Proposed Use of Budding <br />Mail AtlCress <br />Mail Adtlress <br />City <br />i �5 <br />City <br />l' <br />Description of Work ;o Be Done: C �l'l�7(� 1'��Y Lr �,..)E�� � l C�' <br />--T � <br />NOTE. WIRING IN NON-DWELLINGS IS RE�UIkED TO <br />BE IN RACEWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br />/I'J <br />l,va 98�G�! <br />State.2ip <br />State2ip <br />L��rL � <br />Stale2ip <br />�taG�•U�t'-G9�� <br />F'hone <br />P�one <br />`Y�J �y�' <br />Phone <br />Con:ract Pnce of Work <br />_/-�C{r"r!� �f�ila�!)�1Ji�l{ti'fit/1�, <br />Co�qtaclPerson (Plan Review). • <br />FfanJ��C•,Yd/�5 L'rr,lA�sElt��rr�e� <br />' I ne�eby =ertil/ t��a: ' have read and exammed ;h�s applicaticn and know the same to be true and <br />:crrec:. All prcv�sicns af laws and e�dinances �ovemmq fhis type o( �.verk wtll be completed <br />�inether;pecJied ne�ein cr.ioc 7he granung c� a permd oces not presume ro give authonty to <br />� rioiate �r cancel fhP „i, visions ol any other state cr ieca! law regula6ng construction or the <br />I. peAormance ol ce. isrruct�on. rhat I am authonred by the owner or thrs property �o perform the <br />' �.vork lor which application �s made and i c�mply wdh fhe State Ccntractors Law 18.27 RCW and <br />296200 WAC. <br />LR- <br />,�D�P�� <br />FEE <br />Jr c Z� <br />F� � G'�l.% - j (G <br />r <br />