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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> �—_ r- C <br /> � �i� � Z- d�✓(�/� ���C��'� �Qc� <br /> �-�—--'r— J <br /> � :,_`_i..�,`��r.._ .7 ' ��.�U <br /> PROJECT ADDRESS <br /> L �I � `�.�lli1\II �I�l` �.- �.� i�l�� ( ,�1,��)� fl��.'' "t�.� I_..,1,`�lfii , `iI �f.. �l(�JL.`�t.-1• <br /> _ � � <br /> Gwner Mail Address City StatelZip Phone <br /> % <br /> Tenanl Mail Address City StatelZip Phone <br /> 1 n �.. , � <br /> _ _{ +_ � iJ J , I�� `i !,_� �•' �'��r'1;�� �?.�� `7i,7 .'.iL.� L'•ZS'='� � ..��J� ,� <br /> Eleclrical Conlractor Mail Address City State2�p Phone <br /> _ _..__.._ ,..�����•�, <br /> r—'"_ , <br /> Slate License Number Contract Price of Work <br /> _ � <br /> '+F--V��1 �f.�.�,1%�A�i, r �� ;)�L-��''�>i�)'.. <br /> Proposed Use of Building Contacl Person (Plan Review) <br /> Description o(Work lo Be Done: +�1_��� ��+ r v � ��ll' �+ L.t'�r`.a P,1�:` � �:f i��' .4 j� �(N��� �_�: �t_��.���;� i�)�'� � <br /> �`;�i:I'r E !l! �� i�� f'i I�� f"afi,' i"l t i't iix' ( ' '��.�1� 1 <br /> �d� <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE yZ S C <br /> BE IN RACEWAYS, MC OR AC CABLE. T,�cti <br /> � <br /> CITY OF E�ERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerlily Ihat I have read and examined this application and kno�v the same lo be frue and <br /> correcL All provisons o!laws and ordinances govermn�this type o(work K�ill be complefed <br /> whefher speci6ed herein or noL The granting o/a pernut does nof resume to give aufhorrty to <br /> violafe or cancel the provisions ol any other state or local law reguPting construcfion or the <br /> peiforrnance o/conslruc6on. That 1 am aufhorized by the owner o/this property fo perform the <br /> �vork Ior�vhich applicalion is made and 1 comply with Ihe Stafe Contractors Law 18.27 RCW and <br /> 296300 WAC. <br /> � �� -- �r ��-- -- jl. �)c"� -L1: )` <br /> , ,_ . <br /> � SignaWre ' '1 Date <br /> �CJ SC �j —�;S� <br />