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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES 3_3 -O�,/ <br />3200 CEDAR STREET, EVERETT, WA 98201 �0 �� 3r.0U1� <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org l <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />�D�S FL�-�flN � STKC� <br />PROJECT ADDRESS �� 1 <br />�cJV�. <br />� le� �,.�.d�.�r 4 �2� GJ l/,"e� c�a�- <br />Owner Mail Address City <br />Tenant <br />Mail Address <br />Contractor Mail Address <br />�/ i� +� � � *�y 2-D�' <br />State Lfcense Number <br />Proposed Uso o( Building <br />Descriptior, of Work to Be Done: <br />s� � �pti., hA ��� <br />P�OTE: WIRING IN NON-DWELLINGS IS REQUIRED TO <br />BE IN RACEWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX C'JDE IS 3105 <br />City <br />s����(�12,5��3 3 0 � L <br />StaleZp <br />State2ip <br />� <br />ConUact Price of Woric <br />Phona <br />�3�16 <br />Phona <br />�)�s syoy <br />Contact Person (Plan Review) <br />1 hereby certily that I have read and examined this application and know the same fo be true and <br />correcf. All provisions ollaws and ordinances goveming this type ol work will be completed <br />whetherspeci�ed herein ornof. The grenOng ola permd does not presume to give aufhorlry fo <br />violate or cancel the provisions ol any other sfafe or local law regulating construcfion or the <br />per.+ormance o/ construcfion. Thaf 1 am authorized by the owner of this propeRy to parform fhe <br />work Ior which application is made and 1 comply with fhe Sfate Contrac(ors Law 18.27 RCW and <br />296.200 WAC. <br />�� ' <br />Signature o e G � <br />FEE <br />.J��--7 � <br />� <br />�%b � � <br />