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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />a > a �� <br />PROJECT ADDRESS <br />Owner <br />'� I' p S`i-c'r ✓ <br />Ten t <br />��'l�/1 .t' �rK <br />ectrical Contractor <br />3200 CEDAR STREET, EVERETT, WA 98201 a_i6—lU <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org �I <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />,�tC'LJ � -�f /�'V� <br />Mail Address City <br />�.5'l� /�ZC�;7f �kv� <br />;�,..,�,� <br />�+Z=Ev�e.fr <br />Mail Address <br />Address <br />• .cN�s 9z �,v �? <br />Stale L' ense Number <br />,%%>Sui'a���L' S��/-f'Y�io.�1- <br />Proposed Use of 8uilding <br />Cily <br />Cily <br />State/Zip Phone <br />y21' .2 c-o 0 <br />�✓�� ScPZ v / <br />Stale/Zip Phonc <br />r � ) T3/ %!S� <br />%.C,14� �"r �L' i� <br />StatelZip Phone <br />.� ��� � <br />Contract Price o( Work <br />l�T�ftr <br />onlacl Person (Plan Review) <br />Description of Work to �e Done: �/U> �� ��� .���^ n! ^/�'� �`��f lti�� �'�r SS JC �`r' f Y <br />NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO <br />BE IN RACEWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby certily thaf I have read pnd examined fhis applicnfion and know fhe sarne to be truo and <br />coirecl. All provisions o/laws and ortlinHnces goveming this type ol work wil! 6e completed <br />whefher specdied herein or noL The granting o( � pernu( does not resume fo give i�ufhonty to <br />violate or cancel the Provisions of any other sfafe or local law reguPting consWction or tho <br />perlornwnce o/ constiuction. That I am authonzed by the owner ol this property to pedomi the <br />work lor �rhich applic�tion is made and 1 comply wifh the Sfate Confractors Law 18.27 RCW and <br />296.200 WAC. <br />,�— �b—/D <br />FEE <br />Elups-�,�� <br />