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ELECTRICAL PERMIT APPLICATION <br />CITY nF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCE°7ED FROM 8 AM TO 4 PM <br />z3zl ? <br />���; ��,�,�'��— ;�c.-c <br />� <br />PROJECT ADDRESS <br />�sn�l� /Gi-%/s /_ � <'//�,,,,�,. <br />Tenanl <br />L�,/., ,�t=� �.;i,s i 5� • �; <br />Mail Address <br />Mail Address <br />_�� � � � `. fiLt/f'�i�ti <br />CoNraclor Mail P.ddress <br />�` r'% ,,S�iL' y 5 � y 2 l �� <br />Slalo Licenso Numbcr <br />r�y <br />Praposed Use o( Building <br />Descriplion of Work to 6e Done: �/ �'� �'<<�/" � <br />NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO <br />RE IN RACEWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br />�t%;'i c-'L/ <br />Cily <br />Ciry -- <br />;c`-��' <br />Clly <br />�c � `I�� � - <br />Stale/Zip <br />State/Zip <br />%%'� / <br />Slate/Zip <br />j D ��-7--0� <br />�� �/o—/c�'� <br />yzs -37%-GJ <br />Phone <br />Phone <br />�fz>-z��-�-/� <br />Phone <br />�/���� == <br />Conlracl Price of Work <br />��/�ci /r�/ <br />Contacl Person (Plan Review) <br />" ��: q �/�t�'i - — / S�i T <br />FEE <br />1 heroby certif}� Uwf 1 have read and exarnined fhis application end know fhe same fo be frue and <br />correct. All provisions olla�vs and orAinances go��ernmg fhis type oI work will be completed ��jQ, � p 1 C 1 <br />whether spca�ed herein or not. The c�ranfinr� ol a perrmt does nof presume fo give aufhonry to <br />violafe or cancel the provisions ol an}� ofher sfato or local la�v re�ulafing construcfion or fhe <br />peiformance o/construction. Thaf I mn nuthonzed by the owner oI fhis property to perfomi the <br />wo�k !or �vliich applicalion is made and 1 comply wilh tl�e Sfate Confracfors Lnw 18.27 RCW and <br />296.200 Ih�AC. <br />•' � . ! �-- <br />, _����'��/i��l! i�- ,-, _�•`� . <br />Signature Dalo <br />