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ELECTRICAL PERMIT APPLIC,�ATiON <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR S'(REET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-?_57-8857 — www.everett•.va.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />C��, / � t�' <br />PROJECTADDRESS ' <br />(Ui�� 7c� r-r� uc: C��/ ��; ;,_`',•/ <br />Owne� Mail Address Cily Stale/Zip Phone <br />S <br />Tenanl <br />Mail Address <br />State/Zip <br />Phonc <br />t , G✓� ���'J.� 3 <br />/',',,.�s1��.._� /`/r�/,e_I.e /-�i,� �Y�i /%/.-. o.-, <br />[lectrical Conlreclor Mail Address Cily Slale/Zip Phone <br />� i�( �i '--��>�%�(i ! 7i�� � <br />Slate License Number <br />.f.✓. C <br />Proposed Use of Building <br />U�scr�plion of Work to 6e Donc: <br />O / / /f���fj�Y.. /- <br />/S U �; <br />Contract Price o( Work <br />Conlact Person (Plan Review) <br />�.; /�- z f- <br />; : li., ,<: . G,��� �� ��/� . �� � �...�.J"1.,� ��C � � /o <'. P� /�f/�., <br />i �—� I ' —T <br />% i' i' � <br />DlOTE: WIRING IN NON-DINELLINGS IS REQUIRED TO FEE <br />DE IN RAC[WAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I herehy certily that I have read and examined Riis application and know thc sarne to be true and <br />correcL All provisions o( laws and ordoiances c�ovemmg this type o! work �•�ill ba compieted � �`I I— C� � <br />�:hefherspecdied herein ornoL The �rmitin� o(a pennif does nof resume �o give authonty fo <br />violate or cancel the provisions of any other state or local law re�uPating constructwn orthe <br />performance o/ consfruc6on. That I am aufhoiized by the o�vner o! fhis property to pedorm the <br />�vork lor which applica; �n is nrede and I compty �vith Ihe State Contractors Luw 18.27 RCW and <br />296.200 WAC. <br />,�'f' ��<c� �i;�: ��-, <br />