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ELECTRICAL PERMIT APPLICATIOIV <br /> CITY Qr EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETf, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 -www.everettwa.org � Z —(;�—G� 7 <br /> / <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �L�7� �—/�/ <br /> [�70�- �UP✓�f�ri ��/a� �t/er'ef� CU/� 9cf'ao� <br /> i <br /> PROJECT ADDRESS <br /> �au:� (Ln�,- �� oa C er�ree,,, c��•y �t/ere.ff CUA 9�'a-r�SL �f-- JJa-1 r'� <br /> Owner Mail Addre.�s Ciry Slate2ip Phone <br /> �c�U:�1 I<:-;ww ��o� �t�..7rea,.« Gd,cay rtier�N CvA �� � �t`-�Iv�-��f'J <br /> Tenanl Mail Address � City Stale/Zip Phone <br /> ('-Ufll�t -`�5'n, �(si� /�'��1� Nu/j'� 9�i #� Lyo�i�w��u� �uA ��37 �"�- 9/�7- 7� <br /> Eleclrical Contraclor A4ail Address City Slate/Zip Phone <br /> �uN1 +C U= 9� Gc� <br /> State License Number Conlracl Price of Work <br /> Proposed Use of Building Conlact Person (Plan Review) <br /> Descriplion of Work lo Be Done: <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 /> 1 heieby certily(hat f have read and examined fhis applicafion and kno�v the sane to be true and <br /> correct. All provisions o/laws and ordinances c�oveming this type ol woii<will6e completed <br /> whether specdied herein or not. The granting o(a penmt does not resume to give aufhority to <br /> vio/ate or cance/the�rovisions ol any ofher state or local law reguPting construction or the <br /> peAormance o(construction. That 1 am authorized by the owner o/this property fo pedorm the <br /> wo�k Ior�vhich application is made and I comp/y wilh Ihe Sfate Contr�ctors Law 18.27 RCW and <br /> 296.200 WAC. <br /> / ---� ----�— �1��9� 1'c-u 7 <br /> Signature Date <br /> r- �llc�-I � � <br />