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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 /> l/'� l �//a TT �-�l A-�' <br /> PROJECT ADDRESS <br /> C/���,� /��'G,o,J //�/7 3 5 '�`' 1�,� Sr�" F[.'�r�`i wr� `7,�'��5 <br /> Owner Mail Address Clly Stale2ip Phone <br /> C�I1N �iC'Ii�GN �I��i� <br /> Tenanl Mail Address Cily StatelZip Phone <br /> G/�,,,� �7<<; vJ ,�i��� f <br /> EleClriC21 CoNraclor M1toil Address City Slate/Zip Phooe <br /> Slate License Number Conlracl Price o(Work <br /> ��s,��.; �,� ��„a i�l�,c�.,.J <br /> Proposed Uso of Building Conlacl Person (Pian Review) <br /> Descriplion of Work lo De Donc: � ''�: �� .„ ..i " ;'� j. '= /J-�`�,�G'/i[/ D-f��FS—//J/rISS- <br /> J / ,� <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FtE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY 0�EVERETf LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerii(ylhaf 1 fiave read and exarnined Iliis app/icntion and knew fho sa�tie fo be tn�e and <br /> correct. All provisiais of laws and ordinancos goveming fhis type of werk will be completed <br /> whether specified herein or noL The granfing of e ponnit does not rosumo to givo nuthonty fo <br /> violateorcancelthe provisionsolonyofhersfafeorlocalla�vre�uPtingconsWcfionorthe <br /> perfomiance oI construcfion. rhnt 1 am aidhonzed b}�Ihe owner o/this propert}�to perfonn fhe <br /> work lor which ap licafion is made and 1 cornply wifh the Stafe Contracfors Law 18.27 RC�M1�and <br /> 296.200 WAC/ <br /> � i ,._,,.� L7� � ' `- D� r ��U`1 v I� <br /> - Signature ,/ Uata <br /> / <br /> � <br />