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ELECTRICAL PERMIT APPLIGATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX425-257-8857—www.everettwa.org lO��g��� <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM `'�� /jJ'�/� <br />I5 SUJ L'Vt�c��'t IvI���L1 ��cz� <br />PROJECT ADDRESS — <br />f�lcli <br />Tenant <br />L let_-t t iC u <br />ElecUical Contraclor <br />Mail Address <br />Mail Address � � <br />; ��t N. � <br />Mail AAdress <br />i%,Li%1:.7�1��! � �'�::.,�� `I'�_ <br />State License Number <br />�i-I t'i �.1.`�I'1 ('..�I.il�� 1�(+� <br />Proposed Use of Building <br />�escriplion of Work lo Be Done: <br />NOTE: WIRING IN NON-DWCLLINGS IS REQUIRED TO <br />BE IN RACEWAYS, MC OR AC CABLE . <br />CITY OF EVERETT LOCAL SALES TAX CODG IS 9105 <br />l+�le, u.`� <br />Cily Slate/Zip <br />ll lU�zJi ��;er�'�t, �.�i� �ig <br />Cily � SlatelZip <br />Cily <br />��r� �l^�7 <br />State/Zip <br />.�-�.3J� <br />Plione <br />C�Z4-�k.i. <br />Phone <br />��{�— <br />� �f K11=i � l �S <br />Phone <br />�' °�C'O`' <br />Contract Price o( Work <br />��'�i�r��>n N<tt�.t�l,LG� <br />Contact Person (Plan Review) <br />1 hereby certi/y lli, f 1 have read and examinod f0is applica(ion and kno�v Iho samo (o Ge lnr� and <br />correcL All provisions o( laws and ordinances goveming Ihis typo o/ �vark will be compleled <br />�vhelher speaGed horein or not. 76e granfing ol a pennd does not resume to givo aufhonty (o <br />violate or cancel Ihe r�rovisions oI any ofher sfafo or /ocal law re�uPfing conshuc6on or fhe <br />perfonnance olconstrucfion. Thaf I am aufhorized by fha ownerof this properiy fo porlonn fhe <br />work Ior which appl�ca6on is rnado and I compty with fhe S(ate Contracfors Law 1627 RCW and <br />296200 WAC. <br />l � �" � <br />llr(i /i(�(i l�.'wCl�li�. IC -j:� -j�� <br />FEE <br />— � c(; <br />��(, � — <br />� 1 0 _ % � � <br />� <br />