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ELECTRICAL PERMIT APPi.ICATION <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 />�� ��i � /=���i Di'� <br />PROJECT ADDRESS <br />/i/Vl L"' S l=! i=�.i-1� <br />oW��� <br />Tenant <br />itl��iN� <br />[lectrical Contractor <br />Mail Address <br />Mail Address <br />1� ��=C. ) l�l C. <br />Mail Address <br />i�( �- C:;1 N L' C, l'`�c' 3 1�1 J <br />Slate License Number <br />Ciry <br />Ciry <br />Cily <br />Proposed Use of Building <br />Descriplion o( Work lo Be Done: __ �� �= I�II 1 j� �i J�•� n V� <br />NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO <br />BF IN RACEWAYS, MC OR AC CABLE. <br />c i:: OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />State2ip <br />State/Zip <br />State/Zip <br />Contracl Price of Work <br />Contact Person (Pian Review) <br />1�'1I�51 <br />I here6y ce�tily fhaf / have read and examined this applicafion and know tlre same to be true and <br />correcL All provisions ol laws and ordinances governing this type o/ work will be canplefed <br />whether speaGed herein or noL The granfin� o/ a penmt does nof rnsume to give aufhonty fo <br />violafe o� cancel the provisions olany other sfafe or loca/law reruPfing cons(ruction or the <br />pe�formance oI cons(rucfion. That 1 am authonzed by the ownePol this property to perlomi fhe <br />wo�k lor which applicafion is made and I comply with the Sfafe Contractors Law 18.27 RCW and <br />296.200 WAC. <br />m <br />3 3�-bG, <br />I �10 /'.►��11' <br />FEE <br />� �_ d`� <br />Eu�Oc�3-/6�, <br />I'hone <br />Phone <br />Phone <br />