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EL�i�TRICAL PERMIT A�PLI�A�'ION <br />CITY OF EVERETT f�ERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 96101 <br />425-257-8810 - FAX 425-257-SII57 -- www.everett�va.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />3�3► t�cT �E <br />PROJECT ADDRESS <br />�`17`rolL� Q(�AJE2��ES �45L�- <br />Owner Mail Address <br />D 3 "-�' /� t/� <br />City <br />�-r7 - o� <br />C—a5c�9 �063 <br />r��`w fgoi/ <br />State2ip <br />WFsrFo�� ���— 3m3� ��rr.rdc �,,� sa��i <br />Tenanl Mail Address Cily State/Zip <br />Phcnc <br />y��5- <br />'t.�-`r- s-i a s <br />Phune <br />a;i <br />i}��c�e�Li�'-� 5c�_�.�c�3 /lf'Zyti iF-er-Kj�..:;�ti:�lti� �;;,i7te�.L k"�� �L'i'!/ i�f}-IIL�'/ <br />Eleclrical Coniractor Mall Address City Slate/Zip Phone <br />�4�7� 5�=��yt 7�z�5 <br />State License Num6er <br />F�ropased Use of Building <br />Description af Work to Be Done: I Ns��"'�— �F�� <br />NOTE: WIRING IN NON-DNJELLINGS IS �.EQUIRED TO <br />BE IN RACEWAYS, MC OR AC CA�LE. <br />CITY OF EVERETT LOCAL SALES TAX CJDE �5 3105 <br />Sao. �. <br />Contract Price of WorA <br />�_'::•, i'xx 2�3.3 }? -Ilt.��+ <br />Contact Person (Plan Review) <br />G�;ti cysi��n.cJ �!Z �3E�✓ic��s� <br />FEE <br />1 herehy certi/y fhnt I have reaA anAexa,nin�d this applicafion and know fhe same fo be We and <br />correcL All provisions o/ laws and ordmances gr, vemmg this typo ol �rork will be complefed <br />whefl�er speci/ied l�e�ein or nof. The granfing ol a permrt does noi presume to give authonty to <br />violafe or cancel fhe provisions ol any olher slate or!ocal law iepmafing consf�ucfion or fhe <br />peAormance a/ consbucfion. That ! am iufhonzed by fhe owner ol:h;s property to peAom� fhe <br />�vork lor wh�ch applicatron is made and I wmply wifh the State C�ntracfors La�v 19.27 RCW' and <br />29f.200 WAC <br />