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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT F�RM! � �ERVICES <br />3200 CEDAR STREET, EVEKETT, WA 98201 <br />425-257-8810 - FAX 42 �-257-8857 — www.everetlwa.org <br />APPLICATIONS ARE ACCcPTED FROM 8 AM TO 4 PM <br />77aSEu��z��v W�v �� 1c�2, �v��w r� <br />PROJFCT ADDRESS <br />IAail Address <br />Ciiy <br />State2ip <br />Phane <br />XFi��TV 7�z�a� �v�u� r•t�r�,� iooz ��rcerr��/� 9g2o3 <br />Tenanl I,�a�l AGdress Cny State2ip Phone <br />�U�.��zTsorJhih�JS�x��cE �2oQ �z�� �J.�, T�coi��� r�� �k�-�_o—�__ <br />ElectriCal Conlraclor lda�l Address City Stalel2ip Phone <br />(�U�T`iE551�s5'L-I ��'IV ��(o�'J, OC7 <br />State License Number Contract Price of Work <br />('n�vt�1�C��a� �1Cis1ev�1�_ �'Llf-�inl�l�ti� <br />Proposed Use of Building Conlact Person (Plan Revievr) <br />Description o( Work to Be Done: {-� �nl� Ci (� �j//�i S T%) EX/S 7'1 1%� �L.�C 1'IZ' I C l� �— <br />NOTE: WIRING IN NON-DW[LLINGS IS REQUIR[D TO <br />BE IN RACEWAYS, P✓1C OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 he�eby certily fhat 1 bave �ead and examined fhis applicafion and know Ihe same to be true and <br />correcL All provisions ollaws and ordinances govem�ng this type o/ work will be compleled <br />whefher speciGed herein or noL The g�anlmg oI a pennrt does not resume to give aufhonty to <br />vio/ate or cancel the provisions ol any other sfate or focal law reguPting consVuction or Ihe <br />perlonnance ol constiucfion. lhat I am aulho�ized by Ihe owner o/ Ihis propert}� fo perfo�m the <br />work lor �vhich applicafion is made and 1 comply �vith the Stale Confrac(ors Law 18 27 RC W and <br />296.200 WAC. � <br />FEE <br />�D °b <br />�r�IZ-0�� <br />