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Rpr 27 ❑6 01:02p Rction Electric 3606538534 p•1 <br />ELECTRICAL PER��tiT APPLICATION <br />CITY OF EVERETT PE�2MlT SERVICES <br />3200 CEDAR STREET, EV(=RETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — wvrn�.everethva.org <br />APPLICATIONS ARE ACCEPTcD FROPd S AM TO 4 PM <br />I 1� W. I nk�r �-�- -- <br />PROJECT ADDRESS <br />Owner <br />11 �1 vJ ��s <br />M11ail Fddress <br />i enant Mail �ddress <br />�--lCit'v�� �CI�e.Y��eSi�(1C• <br />�. . �,� _ <br />ElectricalCantradcr MailAddress <br />G•��l�l °I �11- C.� <br />State License Plumber <br />.� {— � <br />Proposed Uso ��f Building <br />Description uf Work to Be Done: <br />NOT6: UVIRING IN NON-DWELLINGS IS REQUIRED TO <br />6[ IN FACEV��AYS, MC OR AC CAB'_E. <br />CITY OF EVER[TT LOCAL SALES TAX CO�E IS J105 <br />Ciry <br />City <br />SWtelZip <br />Sta:c2lp <br />� �-} I �8 . � <br />Contract Pricc of Work <br />Contacl Person (Plan Review) <br />� j'�ex'Y1.2 ( <br />! he�eby certi(y tlm[ I have read and ezamined Ilris appllca(Iqn and kno�r the same fo bo 6ue and <br />curiecL All p�ovisions ollan•s and ordinances governing Uvs typo ef work �vill be cornplef�d <br />whelher spocdiod heicin o��7oL Thc gran!in� o/a permrt does not �esume fo give aufhonfy to <br />��iolate or cancel tho provlsions of any other state or local lau� reguPfiny cons(rucfion or iho <br />perlum�ance ol consfrocticn. Thal I am au[honzed by tha owner o/ flas properiy m perfenn the <br />�vc�k /or �t-Irich application is made and ! comply �vith !hv Stafc Confractors Low 78.27 RCl1� and <br />29ti.200 LYAC. <br />� �igna ure � � <br />I <br />�_'_- _ _ ____ <br />�- <br />1�.�1��'7 ) �� C? � J���'�� c,% <br />FEE <br />S5 . `� <br />i� <br />� I _ � ('� ✓ <br />��� <br />I,� <br />Fhcne <br />Phone <br />