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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 />, <br />�� ( �'/H.--,��,! fs�a'��. <br />PROJECT ADDRESS <br />•i.. <br />�.,� ,; .;. %i _��, aiy,•;,, , <br />Owner <br />Tenant <br />r�3,'^s� �i..'%i,/ � <br />Electrical Conlreclor <br />Mail Address <br />F%� <br />Mail Address <br />di ;;" %c7 � T %S 5'� �"�' <br />Slate License Number <br />i <br />f/c.-�� <br />Proposed Use of Building <br />Descriplion of Work lo Be Done: �^ <br />�i(.'. F�� �"� I� <br />Clty <br />Cily <br />StateZp <br />Slate/Z(p <br />% <br />Phone <br />Phone <br />;..� 27/.J i�.v„/9�/,Fe /��n,�� !� S':07 ; y15 S37 Z�6t� <br />NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO <br />BE IN RACEWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TA:: CODE IS 3105 <br />Cily <br />StatefLip <br />Z S'<'>C� . c� � � <br />Contract Price of Work <br />Conlacl Person (Plan Review) <br />/ hereby certi/y that 1 have read und examined Ihis epplicalion and know fhe same fo be We and <br />correct. All provlsions o(laws and ordinances goveming this type o( work will be completed <br />whelher speafied herein or noL Tho granting o( a permit does not prosume to give authonty to <br />viola(o or cancel tho provisions ol any other state or local law regulating consfruction or the <br />perfomiance o( consiruction. Thnt 1 am authonzed 6y the owner o( thls property to pedorm the <br />work for whicn applicalion is made and 1 comply with fhe State Confrac(ors Law 18.27 RCW and <br />296.200 WAC. <br />-�-- <br />_ _ _ _'�':!� �G - S � �� <br />Signature Date <br />FEE <br />75� <br />Phone <br />�l I I z - D�,� <br />