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ELECTR�CAL PERMIT APPLICATION <br />CITY OF EVERETT PERIVlIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8�10 - FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />.< �2 <br />`<'^,/�r'"� Lr:^Il fjr�•,�-1�� F1UE_ �=�1� <br />PROJECT ADDRESS <br />owi�er <br />Tenant <br />�=�. ` � r rr. )' . <br />r.t��i Hd<i«ss <br />A4:id ! �Idress <br />City <br />Cily <br />SlatelZip <br />State/Zip <br />4�0��0� <br />�:-0 8o v -o u 3 <br />Phone <br />Phone <br />S�MMITELCc,TS'�c. �'Lc�S 1�ISrSf rv� STNN�D c�A `�825'1- `-125 30� S�Sq <br />Electrical Contraclor Mail Address Cily State2ip Phone <br />5<� r� M l C I ov o�Z., <br />State License Number <br />n!Jt'i.�i� <br />Proposed Use of Buildin9 <br />Description of Work to Be Done: <br />��C <br />NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO <br />DE IN RACEWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I 2.c, �� <br />Coniracl Price of Work <br />Conlact Person (Plan Revie�v) <br />( TU TI� l. <br />%��JC� A"wo I�rr�7S <br />I hereby certi(y thaf 1 have read and exarnined fhis application and know the same to be true and <br />correcL AIf provisions of la�vs and ordinances governuig fh�s fype o/ woik u�ill be completed <br />�vhether specdied herein or noL The c�ranfing o( a perrnrt does not resume ro give authonty to <br />vielate or cance/ the provisions ol any other state or/ocal lau� reguPting construction or fhe <br />perlormance of constructron. Thaf 1 am aufhorized by fhe o�vner o( fhis properf� ro per/orm fhe <br />wo�k for which application is made and I comply with (he Stafe Contractors La�v 18.27 RCW and <br />296200 WAC. <br />._.._ � �--_ /� F�,� <br />FEE <br />.— L�'�ti.{ _�'ii� <br />