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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 �_�.Z—�� <br />425-257-6810 - FAX 425-257-8857 – wvrw.everettwa.org D�I <br />� /DO /- <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />� � ' ( y i� I ! � . �: A' �"� 'r ' <br />PROJECT ADDRESS <br />Ovmer <br />� la i., �- <br />Tenanl <br />, _ YI`ti <br />/ � ir�i�n� �'i • ����o'� -�i�� ��ir /"_4� �.'< i• U� hY'. >; 'i' - - <br />fdall hdtlress� Cily Slate/Z�p Phonc <br />M11ail Atldress <br />Ci�y <br />State/Zip Phona <br />��.1 ii!i. F.� /.', f' l�:1 �^��ii � 7 ��r_ i,Fr.il� ��. �� `% � j���t i� _ �)��%.��%� <br />[IeCtfIC�ICOntraclof fAailAtldress Gty SIa1c/Zip Phona <br />►11 J i i 1 �l _ �•"� <br />Sta�e License Number <br />Proposed Use of Ouildinc� <br />ConUact Piice of Wark <br />Contact Person (Plan Review) <br />Descriptian o( Wb�k lo De Done: � i^ 1 ,.l (` H���- �� i k�' ',� " !�' c I�. �- z r"� �_ � _ <br />,-.�V� 11�i �,\h n� �1 <br />NOTE: WIRING IN NC�N-DVJ[LLINGS IS REQUIR[D TO f-EE <br />�[ IN RACENiAYS, IJIC OR AC CA�L[. <br />CITY OF EVERET7 LOCAL SALES TAX CODE IS 3105 <br />1 herehy certi(y (hait I have iead unG ex�^mined this npplicnfion nnU know fhe sarne fo Ge tnio and �' <br />conecl. All prowstens o/laws ond ordirrances po� mn�ny (I�is type oI �rmlc wil� be comple(vcl � I �,� �-- (J �! <br />wAcfl�ersper.ilicd herein or noL The granlin;� ol a pem�:( doos not presumo lo c�ive aufhority fo <br />violnfe or cancn.l:he I�rovisiors ol any ofhersl?to orlocal !mv mgulal�ng conslniclwn or the <br />peAoirnance ol cons(nicfion. Thaf 1 nm a�ilhcnzed by (hu o��+�nero/ flus properiy fo perfonn the <br />worlc lor rrliich ��pp�ication is rnacle and ! conrply �rith !hc Statc Con(raclors La�v 18.27 RCW and <br />29G.200 WAC. <br />�. - � — � - - i „ <br />� <br />. Signalure Datc , <br />