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ELECTRICAL PERMIT APPLICATION <br />CITY OF EV�RETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 �,-�l� _� z. <br />425-257-8810 - FAX 425-257-8857 — www•everettwa.org � �,� _ � � 5 <br />APPLICATIONS ARE ACCEPTED FRUM 8 AM TO 4 PM <br />�3 � � U °n � l�Crih 17A� <br />PROJECT ADDRESS � <br />��� <br />Ownei <br />Tenant <br />�J' (5�,;11,� �C 4`1�0 ���,ti�., Uw <br />� <br />Mail Address <br />S t� �� id a✓�,� V�'� �s <br />--�r� <br />Mail Addres: <br />l�e.. �lO�.fTI✓ ��/1I� ///i,'N%� lrl�. <br />Eleclrical <br />�f/3cc�'s�lbin�� <br />State License Number <br />� r � rc rs <br />Proposed Use of Building <br />Description of Work to Be Done: <br />Mail Address <br />NOTE: WIRING IN NON-DWELLINGS IS REGIUIRED TO <br />BE IN RACEWAYS, MC OR AC CABI.E. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3�iG;. <br />I hereby certi(y fhat 1 have read and examined Ibis applic. <br />conecL All prov�sions of laws and ordinances goveming � <br />whcther spea(ed herein ornoL The granting ola permd <br />violafe or cancel the provis:ons o/any otherstafe or local <br />peAormance olconstruction. That � am authorized by the <br />v�ork !o� which ap an is made and 1 comply wifh the � <br />296.200 WAC. � �-, , <br />City <br />Cily <br />City <br />y zs'- y3P � lG? <br />Slale/Zip Phone <br />�- y�'�y <br />State/Zip y?r-�/n,nG 3 <br />cti � <br />�/�- 9d"Zo 3 <br />SWIe/Zip Phane <br />/O� �ve Y <br />Conlracl Price of Work <br />Sc� � /%�J� rf� <br />Contact Person (Plan Review) <br />tion and know the same to be true and <br />his type ol work will be completed <br />loes not resume lo give authonty to <br />'aw reguPfing consVuchon or fhe <br />owner o/ this propeAy to peAorm the <br />�tate Confracfors Law i8.27 RCW and <br />y�Z <br />FEE <br />I � � �� <br />E1Zo�( � �25 <br />