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( <br />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 � e,r �-� �B (� <br />�'� I S �I�JF�' � (`�CI �l/l'r� %1��,��j �� c(���� <br />PROJECT ADDRESS <br />�� <br />Tenant <br />MIK�S�t1ga <br />Eleclrical Contraclor <br />Mail Adoress <br />Mail <br />hlail Addiess <br />Mir<�stiso��; ��� <br />State icense Number ` <br />Proposed Use of Building <br />Descriplion o( Work to Be Done: <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 3705 <br />I hereby certrly that 1 have read <br />cnrrecL All provisions o/ laws s <br />whefher specilied hemin or nof. <br />violafe or cancel fhe provisrons <br />poAomrance ol construction. T <br />work )or which applicafron is ma <br />296.200 W.4C. <br />Cily <br />� <br />Cny <br />r <br />o �,,;�: <br />State2ip <br />Phone <br />/h�one <br />i ZS� <br />City Slate/Zip Phone <br />�a/'», <br />Uv <br />ContreG nce ot Work <br />Contact Person (Plan Review) <br />fhis applicafion and kno�v the same to be frue and <br />govemmg tlus type o/ work will be romplefed <br />�/ a nemut does not oresume to aive aufhontv fo <br />Signaturc Date <br />and <br />�Gi=�(J-1 �� <br />FEE <br />