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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 /> � � SaO <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM C- I 00 � —� <br /> � �, .- <br /> ,l� 0 � ����I��t A�� 7�b'��,r <br /> PROJECT ADDRESS <br /> L���,� ,4�1�1 � ��� 3l6 - o�l( <br /> Owner Mail Address Cily Stale/Zip � Phone <br /> �<<� y� �s� - ����� <br /> Tenanl Mail Address City State2ip Phone <br /> �.�c` �{ �...�.,� f;ICc�ci� �`�6��( /t���J� i /�Cu Gi�" n�[�v J��i� 1/'� L /��!-�,.�<-� )151�'6��'� <br /> Elec rical Conlrac�or �1ail Address City State2in �Y�5 7 Phone <br /> 7L.� �T � � �� �,� ( ��~ . V� C�. C-Y-� _ <br /> Slale License Number CoNract Price ot VVork <br /> 1'!c�`� <br /> Proposed Use of Building Contacl Person (Flan Review) <br /> � / <br /> Description of Work to �e Done: �� QY1r��`- 1n�� .�.�< C- "�` ��� �'�� ��' �� C� � ( � 5 t� <br />-� <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAI SALES TAX CODE IS 3105 <br /> 1 hereby certily fhat I have read and exarnined this application and knon�the same to Ue tnie and � ^ �`� L� <br /> coirecL All provisions olla�vs and ortirnances goveming fhis f}�pe o/u�ork�rill be completed � �� L- �-5 <br /> �vhefher speci(ied herein or noL The granting ol a pernut does not resume to gi��e authonty fo <br /> violate or cancel the pro��isions o!any other state er loca/la�v rec�uPting censfnicfion or the <br /> peiformance o/cons(ruction. rhat 1 am aulhoiized by the o�rner o/fhis property fo perlomi fhe <br /> �vork lor which applicafion is made and 1 comply�vifh flie Sfafe Con6ectors Law 18.�7 RCll�and <br /> 296.200 11�AC. <br /> � <br /> : _, <br /> % - � <br /> _ _ � <br /> ',�,� � /��� <br /> � Signature !Data <br />