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�L�CTRI�AL PERI'IIiT APPLiCAiION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT,INA 9E3201 <br />425-257-8810 - FAX 425-257-8857 -- wv✓w.everetl�va.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />� {�Z� � � � �` �.; _ E -�� P��l r� � � �.�: A <br />PROJECT ADDRESS <br />Owncr hlail Addr�ss <br />�(%;� cf. �1- l �- o <br />( � <br />City <br />�� hST�r G+,.,T� 5 _._,___ <br />Tenant Mail Addms;; C:ily <br />SLatelZip <br />Slate/Zip <br />Phonc <br />Phone <br />�!�-�1-1%r'lou�•4Q i i.az.c.'f�-�c. �l�iC ✓S`�� D=-r�/i^�u= `�� S�- iJL� IL��14, L'�A �i�fvS�I <br />E eclrical ConU�,:br Mail Address Ciry State/Zip .z� Phone <br />c ��r�3 �N� <br />`�1a L.��:_cr��Y���-5 i� _ <br />Slale icense Number <br />�L��.'C-{} i L <br />Proposed Use of Building <br />�1�5-�G.00 <br />-r <br />Conlract Price of Work <br />� <br />��'� J ru �.! �%ri:,.(�y:Ti�-�—�. <br />�Contact Persort (Plan Review) <br />Descrip�ionofWorlclof3aDone: ���`-w, �-�����r5 , C'�«Tu�rS� S�+�tu%:5 <br />NOTE: WIRING IN NON-DWELLINGS IS F�QI,iRGD TO <br />BE IN RACEWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES Tv.X CC�YE� 1f1'38�1R <br />1 hereby ceriily thaf 1 have read and exarniueci rl<i.: ��r<,L. n and kno�v fhe same fo be true and <br />conecL All provisions o/ laws and ordinances ;c'�: <-ra,�7� tLrs lyp� oI work will Ge complefed <br />whether spea(ed herein or noL The granfiny rr ,r a e�sr a�f;loes no� c �,ume to �ive authonty fo <br />violate er cancel the provisions ol any other s�:+:. .�'a al lew regulafing construc6on or fhe <br />per'ornrance o(conslrur,fion. That 1 arn 2ufhc, .�-;d by fhe o�vner olfhis property to penc�m the <br />work lor �vhich application is made and I con�ply �a�th the Sfate Confractors Law 1827 RCW and <br />296.200 WAC. <br />��� _.Ki�i� .�� _ � �i�i'��o-� <br />�--'" <br />FEE <br />/ <br />� �. <br />�. �Li <br />-; <br />%� _' <br />