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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES �_ac�_�a <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everetlwa.org �/QD �� 53 <br />��E��� Cti���r�� <br />PROJECT ADDRESS <br />�� ��sHti�rl <br />Owner <br />( �;ir�� <br />Tenant <br />� L�r `1/ <br />Electrical Contractor <br />Slate Lfcense Number <br />Proposed Use of Buildinc� <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />�1j-'�j'.� <br />d4, ��"t��Ti <br />,����� f �j <br />Mall Addross <br />� � <br />,r,�. <br />Descriplion o( Work lo �o Done: <br />Mail Addross <br />Mail Addross <br />��I-1 `I��c(;- <br />NOTE; WIRING IN NON-DW ELLINGS IS REQUIRED TO <br />BE IN RACEWAYS, ti1C OR AC CABLE. <br />CITY OF EVEREIT LOCAL SALES 7AX CODE IS 3105 <br />1 hereby certily thaf I have reod nnd exemined fhis applic <br />correct. All provisions o( Imvs and orciinances govoming <br />whefher specified hemin or noL The c�raifin� ol a pennd <br />vio/afe or cancel the provisions o/ any olher stafe orlccai <br />perfomttince o/construction. That 1 am authorized by the <br />�rork for �vhicli Applicafion !s mAdo and 1 comply wifh the <br />296.200 WAC. . � � <br />� <br />.�I �,� <br />'� � �;, <br />and <br />I_1,1(i Sv�;�'ttj �di� <br />Slate2ip <br />Slale/Zip <br />� 2 <br />S� L l� � <br />Phone <br />Phone <br />�77 �/7� <br />City Slato/Zip Phone <br />�� �5 L� . � <br />� L'' u <br />� _ <br />Contract Price of Work <br />L�b���'� i�i1KC�fc� <br />Conlacl Person (Ptan Review) <br />a fo bo Iruo and <br />cornplefed <br />�o authonty fo <br />tion or the <br />o pedomi the <br />8.27 RC W and <br />; c� (�' <br />FEE <br />� i.7�y - l 5 `3 <br />