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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PEF2MIT SERVICES <br />3200 CEDAR STREET, EVERETT, VVA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED fROM A AM TO 4 PM <br />J v I `j (_�L� . � � <br />PROJECT ADDRESS " <br />�l'�I r <br />l <br />Owner <br />Tenant <br />Mail Address <br />A1ail Address <br />City <br />Ciry <br />SlatelZip <br />Slate/Zip <br />� _a&�o� <br />�' O �5"-�5/ <br />Phonc <br />Phone <br />y2.5 �8 S�Sj <br />;:, r�rr,�� ��Cr�i.�_C�'Lo3 'L61 ;' ST r�w ��Rr��,ll C,�r1 �`6"L��i <br />L=lectrical Coidraclor Mail Address Cily SlalelZip Phone <br />j����.!'C'i�� � Ali�7 t—�- <br />Statc Liccnse Number <br />D��PI�-� <br />Proposed Use of Building <br />Contracl Price of Work <br />Contacl Person (Plan Review) <br />Descriplion o( Work to �e Done: i a� i 1� D( )Q�'� W ��'1� Z1�%iJ rk r,�� 5� (�! IC.(-� <br />� <br />NOTE: WIRING IN NON-DW[LLINGS IS REQUIRED TO <br />BE IN RACEWAYS, MC OR AC CABLE. <br />CITl' OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I liereby cerfily Ihaf I Imve read and e.ramined fhis applicalion and kno�v the san�e to be tnie and <br />„errecf. All provisions o/ /;nvs and ordinances �overning this fype ol work will b� cornpleted <br />�vhelhe�� speci6ed Ircrein or noL The grantinc� oI a permd does not uesr:n�e t� r�rve aufhority to <br />violale er cancel the provisions ol any ofher sfafe or local law regul,�ting cor,struc6on ur the <br />peiformance of cons6uction. TAat I am authorized by fhe owner o/ this property to perform fhe <br />work lo� which application is made and I cornply �vifh the Sfate Contrar;ors L:�w 18.27 RC W and <br />2962G0 WAC. <br />FEE <br />� ���� <br />t � <br />U <br />