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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERDhIT SERVICES <br /> 3200 CEDAR STREET, EVERtTT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> �a �� ,r �� ��' ���f ��1 ,� � C-r ���'��� - <br /> PROJECT ADDRESS <br /> �L �9 .� <br /> �����ic4"'�(� � ���'���nC'� ,y� ��,�� �n�[�ri�l�f�/✓P .�v�� YJ7 �ti�� ��5.,���� -� <br /> Owner Mail Address City State/Zip Phone <br /> Tenanl Mail Address City St2le/Zip Phone <br /> ��/ht'- �1�.,)i El� <br /> Eleclricai Conlraclor Mail Address Ciry Slate/Zip Phone <br /> Slate Lic��nse Number Contract Price of Work <br /> . / / /� <br /> ��' /��� .'!7 ! ��7 / `�l�17i2�1� �j�c��0 E-'S <br /> f <br /> Propused Use of Building ContaclPerson (Plan Reviow) <br /> Description of Work to Be Dono: I GI Y7 r�/ Gi p �l /��7���-� <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby certily fhaf 1 have read and exomined Ihis application and know fhe same to be frue and <br /> correcL All provisions ollaws and ordinanc?s goveming fhis fype ol work wi!1 be cornpleted <br /> whelher spea6ed herein or noL The grar.fing of a permd does nof resume to give aulhonty fo <br /> vio/afe or cancel fhe�rovisions of any other state or local law reguPting conslruction or the <br /> peAornrence oI consirucfion. That 1 am authonzed by fhe o�vner o/this property lo perlorm Ihe <br /> �rak lor nhich applicafion is made and 1 cornply wifh the State Contracfas Law 18.27 RCW and <br /> 29ti.200 WAC. <br /> � + <br /> / '� � <br /> �s�-.�,��� ' ��, ;,ci� I _ Iq_ L� � , � ���" <br /> Signalur � Date <br /> y/ �l <br /> �� <br />