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ELE��TRICAL PERMIT APPLIC,ATION <br />CI'I"Y OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERFTf, WA 98201 <br />42:i-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />�4PPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />�'U � �� ��(� ��ati�-Ltl�( �/ <br />PROJECT ADDRESS <br />'� �' <br />�.c��i����,�� t fo <br />Owner <br />c+� n r �ti�.t,, <br />Tenant <br />. <br />y� � � `�:7 <br />Mail Address <br />Mail Address <br />(L- �ti� ���.'C-L�1 I�t C L- `� �-� <br />Eleclrical Conlractor Mail Address <br />�l It.i ELI'� �'�C,�7%• � 1 ( <br />State License Number <br />�.!��e4�;�,,.� `� <br />Proposed Use of Building <br />Description of Work to Be Done: <br />� <br />'�GO Sr rtfa�i2C� <br />City <br />;,[�% S�r' l�v� GI�aC <br />City <br />i"IV �- �.-t- F .1��- (� �� <br />Cily <br />� � S'� s.fie�pJ <br />Stale�/Z(p Phone <br />S�e_ �� <br />Statci2ip <br />SlaledZip <br />��-� , �t' <br />Contract Pric� of Work <br />Contact Person (Plan Review) <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 />I hereby certily that I have read and examinad this application and know the same to be true and <br />correct. All provisions o/laws and ordinances governing this type o( work will be completed <br />whe�her specified herein or not The granting of a permif does not presume fo give aufhonty to <br />violate or cancel the provisions ol any ofher state or local law rec�ulating construction or the <br />peAormance o/ construction. That 1 am aufhonzed by the owner ol this property fo peAorm the <br />work Ior which application is made and 1 comply with the Stafe Contractors Law 18.27 RCW and <br />296.200 WAC. <br />Phone <br />Phone <br />� -/,��'D <br />� �.� � �_ � �:.: , �,t_ �� 2-1-� �, � �n�:� <br />