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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, VJA 98201 <br />425-257-8810 - FAX 425-257-8857 -- wv,w.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CkEDIT CARDS ARE NUT ACCEPTED <br />� I <br />I �%�� i�i".l.�C-( l UU'l� ���Qf�f'f�" <br />; FROJECT ADDRESS ( LL t � <br />�� f1151)� �Cilif_� <br />Owner <br />Tenant <br />;�� 1 <br />�,��� <br />Mail Aadress <br />� ���-4���✓er��f Lv�t �1�?C�� ��'��''��b'•� %��-- <br />City <br />City <br />State/Zip <br />Slate,'Zip <br />Phone <br />Phone <br />�sz��_SE/ZCh'r�. Cnc. ,�.��ft�-130f1�Dr ti1t 1.1S�t�c'�-,�� ���Sb' �F.2�-3y�-`%'� <br />Electrical Contractor hiail:.da:ess Ciry State�Zip Phone <br />Ci=�DL E.���`11 n'y <br />State License Number <br />L51��n-{�[L.I <br />Proposed Use ot Building <br />Description of Work to Be Done: ��� Y l�Y <<- <br />NOTE: NJIRING IN NON-CWELLINGS IS REQUIRED TO <br />I BE IN RACEWAYS, MC OR AC CABLE. <br />CITY OF EVEkETT LOCAL SALES T!ll( CO�E IS 3105 <br />���✓ <br />Contract Price of Wcrk <br />Z-��2�'�y�y2n4r- %�7'�i5cn�%m <br />Co�+act Person (Plan Revie�v) . <br />h�a_,-,�t�� Ged�_�,�� -(��ad,� El�e. <br />� I hereby certJv 7hat ;!tave road ana exammed (hi; apollcation and know the same lo be true and <br />r,c�rec;. .+Il piowcions e! laws and cidmances gcvem�ng 1h�s rype of .+�ork wdl be complefee <br />.vnether specdied herein or net. ihe gian(irg o! a perm�t dces ncf presume to give a�thonty fo <br />�nelate or cancel Ihe prowsions ol any other stafe or local law regulating construcf.on or the <br />� ped�rmanr,e ol construction. That 1 am au�honzed t:v the owner ol �his property to pedorm the <br />verk lor w/nir, ,3pplication is maae and 1 comply wdh the State Cuntracfus !.a�v 78.27 RCW 3nd <br />� :96.200 W.aC. <br />l� <br />_�, �_c <br />'�-/ �o/p � <br />FEE <br />J����U <br />�� � r�.�- �j'.� <br />