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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES q`�.�_�d <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everethva.org C. /v0 9" ��� <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />��J �S ��G41G��S0�� �(�� <br />PROJECT ADDRESS <br />Owner <br />Tenanl <br />Address <br />Mail Address <br />�] <br />J <br />cicy <br />Ciry <br />�' I�Si d�'31-1�1H`5W l__ ��� <br />Elecirical Contractor Mall Address /� �.� ��(3- ���1 Ciry <br />� <br />�O��fl,�r� s r� 7��3 �` <br />State License um er� <br />� Gt C, I`GY � �/ <br />Proposed Use of Buil ing <br />Stale/Zip <br />Slate2ip <br />Slate2ip <br />C�CD �� <br />Contract Price ot Work <br />�pr9�4/ S �l fvLC �P ,' <br />Contacl Person (Plan Review) <br />Descriplion of Work lo Da Dono: '� ! C' .' � �-'v l' r!' � � r' xP ' c�' �-'r <br />� f'I C� G( �/ C�/l.� r _ <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 thal I have rend and examined fhis npplicnfron and know the same to be We and <br />correct All provisions of la�vs and ordinances goveming this type of work will be complefed <br />whefher specified herein or noL The oranting of a penruf does nof �resun;e fo give authonty to <br />violafeorcancel(he provisionsolnnyofherstafeorlocallawregulafingccnsWctionorthe <br />peifomiance o/ constn�ction. Thal 1 am authonzed by tho owner o/ fhis property to peAomi the <br />work (or which applicafion is m�+do and I comply wifh fho Stafe Controctors Law f8.27 RCW and <br />29f.200 WAC. <br />�------- � � � 7 - � � <br />FEE <br />Phone <br />Phone <br />Phone <br />G��2��i -� L-� <br />