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�LECTRICAL PERMIT �4PPLICATION <br />CITY OF EVERETT PERM17 SERVICES <br />3200 CEUAR STF2EET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-d857 — wv✓w.everettwa.crg <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />� <br />�� i�l; . � rJ-i� �c i ��i <br />PROJECT ADDRESS <br />�� �y r�D���� <br />Owner <br />Tenant <br />Eleclrical Contraclor <br />State License Number <br />Mail Address <br />Mail Address <br />Mail Atldress <br />Ati� ��J:��1T W(�. <br />City <br />City <br />--- City — <br />�jIN%�� (%fvll�'� ��SIDEn1�C <br />Proposed Use of Building <br />Description of W ork to Bc Donr.; I N S� C C_T iL1 �. T L.; ` �j �� <br />NOTE: WIRING IN NON-DWELLINGS IS F2EQUIRED TO <br />B[ IN RACEI�'AYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />`i82c� ( <br />r�- , � r� :- <br />State/Zip Phone <br />Sta�elZip <br />S�a�e/Zip <br />Confrac� Price of Work <br />Conlacl Person (Plan Review) <br />FEE <br />1 hereby certily fha(/ have read and examined ihis application and kno�v the same to be frue and <br />correct. All provisicns ol laws and ordinances gover: ung fhis type o/ �rork �vill Ge complefed <br />whelher specrlied heiein or nnL The granting o/ a perrnd does not resurne to yive aufhority fo <br />violate or cance/ the prrvisions o/any ether state or local law reguPfing cpnsfruction or the <br />performance ol consVuction. That I am authorized by tHe avner olOus property lo peAomi the <br />worN lur which application is made and I cornpl}� �rifli the State Contracfers Law 18.27 RCW and <br />296.200 V�AC. �• <br />/ / <br />� -� � ' � � C_� _ �h /Z `� I CJ >> <br />—� -, � �_ � <br />Eas rr� - I �{3 <br />Phone <br />Phonc <br />