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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 / � ``Z <br /> 425-257-8810 - FAX 425-257-8857 -www.everettwa.org l�'- <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ��z0 b—��� <br /> . � 6nI �� �� S-����� <br /> PROJECT ADDRESS <br /> c. y � L6� u S`9 . �, w. /�2�`��1 � y�6 (y�T�y��s r <br /> ��- io � .�o� � � 3 J- Ph�„e <br /> Owi,9r Mail Address Cdy State2ip <br /> Tenant <br /> � �� Mail Address Cdy Slate2ip Phone <br /> /�v ���- <br /> EleC�riCal Contraclor Mail Address City StatelLp Phone <br /> N�� �� <br /> State License umber Coniract Price of Work <br /> �, ,� �l� ��-,, t� /le)�/.lrn �C <br /> Proposed Use of Building Contact Person (Plan Review) <br /> / �� � r �- <br /> Square Footage(If residenlial new construction,remodel or addition) <br /> -f- ��- 5 �-,%�6 ��-�tY C I� k`� �„�o CA����' 2aa�, <br /> Descriplion of Work lo Be Done: � 0 11�1 <br /> �b ��`/ ���� ,� La.,�,Jn y L �a Sl� �i��,/k- .fo/�t �t�� �-Jr'r /'�/�� <br /> �(�'\ 'n u �;i,.,,� D�, 4�- •�J 6 S�/✓t.e � � ���� (t (' ,/J(,C�"�1 <br /> NOTE: WIRING IN NON-DWELLINGS IS RE�UIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> I <br /> �i CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby certify lh?t I l�ave mad and examined this applicotion and know the same fo be tn�o and �I7/y,,,_ (� ( � <br /> conacG All pmv�sions al laws and ordinances goveminq(his tppe o(work will be complefeA ��"' / <br /> whefherspeci�ed he�em or noL The granting ol a pemut does not presumo to give airthontylo <br /> violale orcancel the q�ovisions olany ofher state orlocallaw regulating construcfion or the <br /> Iperfonnance o(cons(n�cfion. That 1 am autHonzed Uy Ihe owner of tfus property fo perlom�the <br /> �vo�!or which applicafion is ntade and 1 comply with Ihe Stafo Contractors Law 7827 RCW and <br /> 296.200 WAC. <br /> =�-� r ,�r 6 � � I- %Z <br /> i Signature Date <br />