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EL�CT�ICAL PERMIT APPLICATION <br />CITY OF E\�ERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 �3_a—ro <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />EIO� g-0�� <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />� _ � � �� / <br />i~ <br />/ • �r :� <br />PROJECT ADDRESS � <br />,, <br />: , :��/�;� <br />Owner <br />i� ��i:�� <br />Mail Address <br />i //�i ����� <br />Cily <br />Tenant Mail Address Ciry <br />/ ,/� � � �(,����✓�� j� �6�� <br />/% �� %� ��( t � J!� �i � � : J`� �i. �� l C <br />---� <br />EIeCl�ica�CoNraclor MailAddress ���Y <br />, . - f �-- <br />� j �: '/'�- �-�,�,'� i1 �'� �� <br />� /, <br />State License Num6er <br />..', ( � �' 1:.����� . , �i�" <br />rroposed Use of Building <br />Descriplion af N'ork lo Be Done: <br />`,�; _ ,�- <br />n("7•'-:.�(7''� '' <br />, � ��/ <br />��?c.�:;''� �iil�`✓ <br />CO! f � � �/F <br />State2ip Phone <br />�/1.S �f /✓ / .S��i <br />State/Zip Phone <br />Slale/Zip Phonc <br />�1' _�� ,' , <br />�-�( , <br />Conlract Price of Work <br />Conlact Person (Plan Review) <br />//! <br />"i"%� S'Si �� <br />NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEF <br />BE W RACEWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hcieby carti/y fha! 1 havo read anel ezarnined fhis application and know fho same to bo truo and <br />conecl. All provislons o/ laws and ordinances 9oveminc� this type o! �vork �vill be compleled <br />�•.I�ether specifisd herain or not. The �r.�nfmc� of a pernuf does no( �resumo fo give authonty fo <br />violatr, or cancel the provisions o� any ofher sfale or Ir,cal law regu�afing ronsfruc6on or fhu <br />perlornrance ol conslr�clion. Thnt I am authonzed by fhs o�vner o/ this propert� lo pe�forrn the <br />�vork for which application is mad� and 1 comply �vilh Ihe Sfafe Conf�acfors La�v 18.27 RCW anA <br />296.200 WAC. <br />, <br />'% ' � n co 7 <br />, .; „. � � i - <br />' �i r � _ ,��� ( <br />I:innturc � � Date , <br />