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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMfT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 -www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> �S 1 �Co I�`�� �tia .�n,' ---c � o V <br /> PROJECT ADDRESS <br /> ON'ner Mail Address City State2ip Phone <br /> U` \1E��-T-1�,ao�z�c5 3�17t:..��2on1 ,n i 5�'E �ol C��Dx-� W+� �'i'�z�.� �-1z5'ZSti-o�ci <br /> Tenanl hlail Address � Cily State2ip Phono <br /> 4�az-z,-,r1� nr�r 1co�'� 5.� ��c>�sr 1���,- L..lt� q'�n�z �-Iz.S-{�Z,--7��1 <br /> Electrical Conlracto� A1ail Address Ciry Stale2lp Phone <br /> t.�o.�?Zo'rEGC��Z.�.�Z <br /> State License Number Contract Prico of Work <br /> �L i`.r_1�t ?�..�o�_��1L. � ' . <br /> Proposed Use oi Building Contact Person (Plan Review) <br /> 1 <br /> Description of Work lo Bo Done: 1`��-Q • �_ — �r�� --�'�� �•�' ��'z"'^ 3 -Q�� <br /> l_Ca (� `� -'�' -- <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerii/y thaf I have read and examined(his applicafion and kno�v fhe same fo be frue and �� Z�-S � � S <br /> correct. All provisions olla�vs and ordinances goveming fhis typo oI�rcrk will be completed <br /> whefher spec�fieAherein or noL The granting o(a pemut does not xesume to gi�e autiionty:o <br /> violate orcancel iho provisions o/any other stafe orlocal law regulating construc6on or fhe <br /> pedomianco o/cons(rucfion. That 1 am aufho�ized by fAe o�aner o/this I�roperly fo peifomi the <br /> work!or which applicafion is made and!comply with the Sfate Contrac(or.s Law 18.27 RCW and <br /> 296.200 Vti Gy <br /> i <br /> /,- j; <br /> t�� �� .._ �-< <- / _ <br /> j i�'Signalure Data <br />