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ELECTRICAL PERMIT APPLICATION <br />CITY O� EVERETT PERMIT S�RVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 – www.everettwa.org <br />APPLICATIONS qRE ACCEPTED FROM 8 AM TO 4 PM <br />�Ta a� e e%e �f�za► <br />PROJECTADDRESS <br />Owner <br />Tenant <br />Mall Adtlress <br />1•lnil AOCrese <br />Contractor ' MailAddresc <br />�t�wii����a� �� <br />State �icense Number — <br />6LE51 �f/„{�-�-� �[ <br />Proposed Use of Buildmg <br />Deseription of Work to Be Done: <br />cl rcu,i�s � <br />NOTE: WIRING IN NON•DWELLINGS IS REDUIRED TO <br />BE IN RACEWAYS, MC OR AC CABLE. <br />CIIY OF EVERETT IOCAL SALES TAX CODE IS 5105 <br />C�ly <br />Crty <br />Giry <br />5ta;ef2ip <br />State2p <br />Sta�e2�p <br />Phone <br />Phone <br />Pho� <br />$17.�I�.G� <br />Contract Pnce of Work <br />L�][{,-f'C � 2 ci r•� 3� i�( �i� <br />Contsd Person (Plan fteview) <br />/0 <br />FEE <br />I <br />1 hereby cedily that I haw iead and examined t�hisV�am nl�cin s t Ce o,nK o� nin De �mb�et�ed and � U��� H- V�j3 <br />conCcf. Allprovisionsoffawsandord,nances � <br />whe(herspocdred ho�ein orno[ The granting o1 a�m9rt dces not piesu�rre to grve authonry fo <br />pe� manc� o�ronsPiucfio�Tnat i am�authonzed by tire owne�of 7h1s pro�ny �o peN � the <br />work (or �vhich app6ca(i0n is madE and I comply wifh tha Sfete Contrnc.ors Lek� 18 2) RCW an(1 <br />298 200 WAC. <br />Z9/Z9 39yd �I211�3�3 NIM213 ViSLZ9809E LT�ti L001/90/60 <br />