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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 />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />�iZZ QlU+''C�-E-�d�� u�Jr3- <br />PROJECT ADDRESS <br />�-%Th3n-�Stiw� Slixf f.� <br />Owner Mail Atldress Ciry Stale/Zip Phone <br />Tenant <br />Mail Address <br />Electrical CoNractor Mail Address <br />L'(zC ��-� a� 4 �8 G6 <br />Slato License Number <br />�C-n Cs� [.--; • �:� fL{�G�� /�,y �;}�2 G <br />Proposed Usc ot Building � <br />Descriplian o( V:ork lo �e Done: <br />��,�d � 6 d ,� <br />�'n ✓ ���' l_ � <br />�; <br />��Jd <br />NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO <br />BE IN RACEWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAK CODE IS 3105 <br />City <br />Stale2ip <br />� �d-c1m �3OZ S�a.,� GU <br />Phone <br />Cily Slale/Zip � r,�Phone <br />���� " a � <br />Contracl Price of Work <br />,EI� �jd �, <br />L� <br />Conlacl Person (Plan Review) � � � <br />�o��/��" 3 <br />�.��.�'�.� <br />1 he�eby ceriily fhat I have read and exarnined fhis applicafion and kno�v fhe same to be tn�e and <br />conecl. All prowsions o/laws anAortlinances governing Ihis type ol work will be cornpleted <br />whethcr speci�ied herein or nof. The granfin� ol a pernuf does nof �resume to give authonty fo <br />violafe or cancel fhe provisions ol any olher stafe or local law re,qulating consfniction or the <br />performance o/ const�ucfion. That 1 am aufhorized by the owner of fhis property fo pedonn the <br />work for �vhich application is made and I comply wilh the Stafe Conhactors Law 18.27 RCW and <br />29G.200 WAC. <br />(..�. ��_ � -�. — _' ���1�� � � <br />- � �SignaWre Dalc <br />FEE <br />