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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 9820i <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />' �'I�/ L;kl.:l.r.�.,;� /iJ� <br />PROJECT ADDRESS <br />��' ��' � ��fC , �;,; 'S� ., LL L <br />Otivner I.fail Hdd�ess <br />iV � <br />Tenant <br />r � L c'�t c' , <br />Electrical Contrador <br />S�ate License <br />Use ol 6uilding <br />Description o( Work lo �e Done: <br />Mail Add�css <br />Idail Addiess <br />C= �'.--. � 1 «�,� <br />i�� ''� :i' /7r,E 5i <br />Ci�y <br />�� , <br />. a.— � !� LL� <br />NOTE: WIRING IN NON-DWELLINGS IS R[QUIRED TO <br />BE IN RACEWAYS, MC OR AC CABL[. <br />City <br />City <br />f <br />� ��,_,.-d �-1 ����,� <br />Slate2ip <br />StatelZip <br />State/Zip <br />Coniract Pricc of Work <br />Contact Person (Plan Review) <br />�7 � ( L` ; �= <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />! here6y certily fhat I havc rend and ea�arnined this applicafion and knou� fhe sanre lo be true and <br />carrect All provisions clla�vs and o�dinances goverrnng this type o/ �rork �rill Ue completed <br />whefher speci7icd hercin or noL The g�anfing ol a pennd does not vesume fo give outhorify to <br />violalc or cancel (he provisions ol nny ofher stafe or local law regu�afing consfruction or the <br />perfonnance o/const�uction. That I arn eaufhorized bv fhe owner o/ lhis property to peiionn the <br />�vork lor which appiicafion is made a��d I compl}� witli the Sfate Confrac(o�s Law 1 R.27 RCLN and <br />296.200 lh'AC. <br />..'_�' -�So c Z • ,� <br />Phonc <br />Phone <br />Phone <br />FEE <br />� ,.\ <br />�/�l <br />i <br />�� �,i(..,_ � ����`z— `�j fsi ��% � �-� <br />ic . _ <br />Signature . Dale � ��� <br />V <br />