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ELECTRICAL PERMIT �PPLICATiON <br /> CITY OF EVERETT PERMIT S�RVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FF�OM 8,1M TO 4 PM <br /> i 13� s C ���o-�=i �.n� « w�-�i <br /> PROJECT ADDRESS <br /> Owner MailAddress Ciry Slate/Zip Phone <br /> T � N�- x ic f�3 0 5E r�e uw%I-� H�.�� �.1�a-Y E-�:�xi- w n ��>-� � �,z s 3�a8-5 39 <br /> Tenant MailAddress Cify Sta'e/Zip Phons <br /> �,esl�., EtR-��i�'�c: �...�- zz3o A-d��.ds C-�r�-7`r wA `��203 �ZS-z9a-?G3 <br /> Eleclrical Conlrac�or Mail Addrecs City State2ip Phone <br /> — ��; �' sTcr 9 �r3 � �a ' C',�5_d� <br /> Slato License Number Contract Price of Work <br /> r2��=-� � <br /> Proposed Use of Building Conlacl Person (Plan Review) <br /> Descriplion of Work lo Be Dono: -I- �� S T«�� Z C� c ct��Cr��� Cj i �'j�u �'C �v <br /> �j�o i . S 'y�>� fl�,..� S �c1t1 w� <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 /> l hereGy certifj thaf 1 have read and examined this applicalion and know 8;e same fo be truv and <br /> cwrecL All provis(ons of/aws ano ordinances goveming 11iis type o(�rork will Ge completed � (�% �[) •- ii( � <br /> whether specilied herein or noL The granfing of a pernut does not presume to give authonry to <br /> viola(e or cance/the provislons ot anv ofher state or local la�v regulating constiuciron or the <br /> peAormance o(conslruction. That 1 am authonzed 6y the o�vner o(fhis property to perlorm Ihe <br /> work Ior which appl!cafion is mado and l compty�vifh the State Contractors Law 18.27 RCW and <br /> li 296.200 WAC. <br /> i <br /> � v--.�• )-�-�-a- 16 - 5 - � u <br /> Sic�nature Date <br /> , <br />