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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857—www.everettwa.org <br /> � APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -DE81T 8 CREDIT CARDS AR�_NOT ACCEPTED <br /> I <br /> �lov' / /�/iL2��t�f /�/�'�tcP <br /> PROJECTADDRESS <br /> ��ra �i�' 'U c �10.3/ ��A-A.L'N /-} UF 1"Uf.Cr /� ��� <br /> OWner ldail Addreu City � Stale/Zip Phone <br /> ���� <br /> Ten�M Ma1lAddre55 Ciry Sta�e2q Phone — <br /> �310�.�-9 <br /> ��i�. l � Ift �eiur� -,�.i,�c P�J. �3ox /y �� �'.s�us�:�� 1�Gr_� <br /> ElfdnC2lConV0ci0� Maii�mss CAy tate2ip Phone <br /> �/ u�- <br /> ,C7i9� V.G� /99/l�I - ��,'� � <br /> State Licensa Number Contract Price ot Work <br /> \`�� �! i9U � �Fti7T2//'�S'o•C/ <br /> / <br /> Proposed Use o Building Contact Person (Plan Review) <br /> Descnption of Work to Be Done: � %� !:-c .�U9�t" <br /> � <br /> NOTE: WIRING IN NON•DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> !he7eby coRdy thaf I have read and exam;nod fhis application and know the same to be true and <br /> correcL All provis+ons oflaws and ordinances goveming fhis type of wak will be.completed <br /> whalher spea/red horein or noL The grant;ng ol a permrt tloes nol presumo to grve authonfy to <br /> Wolafe or cancel the provisions o!any other state cNocal 7aw regulatmg construchon or fhe <br /> peAormance o/constrvcfion. 7/rat!am authorizetl Dy fhe o�smer of fhis Arope,ly to pedorm tAe <br /> work/or which applica6on rs made and I comply�t�ith the Sfafo Contractors Law 78.27 RCW and <br /> 296200 IYAC. <br /> � � n - <br /> �� . ' � � . �� o <br /> S��g mre Datc <br /> v <br /> ������ �, - j <br /> l •d bES8E5909E �?�z��i3 uoto�y diy :z0 40 bT 1�0 <br />