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ELECTRICAL PCRMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 987.01 <br />425-257-8810 - FAX 47i-257-8857 - wtivw everettwa org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />/ , ;' 'J <br />PROJECT ADDRESS <br />l,� �'(�l�i �j i <br />YZi-- jS�>�-c/S��) <br />r�: Nr4�: !' I�t y"i �..���.:� �✓. hF"Ec,li S'i E7/t't�C�' `j_,��.; _ <br />OWner MatlAd�ress Ci�y StalalZry Phone <br />Tenant Mail AdAress Cily SlalalLp Pnone <br />n /`.i�l'S � <br />�%ai^ri�� �l i���ila�� �N�. %t�y lJ'Orz.��. Nr" �rZ��i11d,,,� (tir4 i S t-�'P�— <br />Electrical Conlrador Ma�l Aadmss C�ry StaidZ�p Nnone <br />� �{N�( Z T�174;i�� <br />Stale License Number <br />i <br />�' Proposed Use ol Bmlding <br />I Desr iotion of Work lo Be Done: A I�' �� '�� �� °� � T <br />NOTE WIRING IN NON DWELLINGS IS REQUIRED TO <br />BE IN RACEWAYS MC OR AC CABLE <br />CITY OF EVERETT LOCAL SALES TAX CODE IS ]105 <br />v rn ��,, <br />Contracl Pnce ol Work <br />Contacl Person (Plan Review) <br />1 hr.�rby rr.RJy Ihat 1 havr rr,id ,uid ��.tnnmeA (hrs appOr,aGon and know fbe 5ame to be Irue and <br />�.unoc! �II provrsions� n� la�ss and nid�nnncus grncrning fh�s fj0e 01 wo�ir wdl ba tomplefed <br />whi�ther specdied he�em ur ��of The yrinnnr� nl n pnmuf Aces not P�sume fo give authonty fo <br />vinlafe w cdncel fhe p�ovisronti ol any o(her stafe o� local law �eywatmg constructiun or Ihe <br />perlonnance ol consfiuchon Thal I �m authonzeA by the owner o/ fhis propoAy fo peAorm fhe <br />work lor whiclt app6c.�hon is made and I[ompl y wdh the Stafe Conhacto�s Law iB.27 RCW and <br />796 200 WAC. '" � ) <br />..�.� �.��. .�1�. /���%,��C�- -- <br />_.__'t._:.�— -'__— ___._..____ ---_ � �- <br />-- Odtlirr ..._ il;���° <br />FEE � <br />/ <br />! /" -) <br />I� _ i <br />c-1 � t_; <br />