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ELECTRICAL PERMIT APPLICATION <br />�-��-09 <br />C�a6��33 <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - rAX 425-257-8857 — www.everetlwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />%GOD �%4telJ�SOI� <br />pROJECT ADDRESS <br />�R�N �ir(Ni � <br />Owner <br />Wt C <br />Tenant <br />'�hl'w�o R. T I <br />Mail Address <br />A9ail Address <br />Eiectrical Conlraclor Maii address <br />l�/�� <br />:csT' 7yf A�rc��rrr� <br />City <br />� .ZNA/dUE�os s,�c�' <br />State License Number <br />�//'���o lcS� /D ����c <br />Proposed Use of Buildii <br />Description oi Work lo Be Done: <br />L=�rc Kb C`��s i��Gr <br />City <br />PG. eo � <br />NOTE: WIRING IN NON-DWELLINGS IS RE4�UIRED TO <br />BE IN RACEWAYS, h4C OR AC CABLE. <br />CITY OF EVtRETT LOCAL SALES TAX CODE IS 3105 <br />City <br />�� <br />L SvS 1�. <br />State/Zip <br />Stale/Zip <br />�' Oz( <br />Phane <br />Phone <br />Qd�� <br />t� State.2ip //u��YmeA¢'f� <br />� � .,l d n. <br />� QUo, <br />Contracl Prt ice of Work <br />�u ��� ���� <br />Contact Person (Plan Review) <br />�(/��i� � <br />I hereby certily that 1 have read and examined this application and know the same to be true and <br />correct Ad prevrsions ol/aws and ordinances goveming this type o( work �vill be completed <br />a-hether sFec��ied herein or ncL The granfing ola permd does nof resume to give authority fo <br />violate or cance/ the provisions o(any other state or local law reguPtiny construction or the <br />perlorman: e of construction. That 1 am aulhorized by fhe owner of this propeRy to perlorm the <br />work Ior which app6cation is made and 1 compty ��ith tbe SWte Contractois Law 78.27 RCW and <br />296.200 W'AC. n <br />C lf/ U��l CG. <br />FEE <br />S1c,q 50 <br />�o�i Ol� - 133 <br />