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Jll, )l. Cl��i u:i�`IA1� <br />lia. uc41 ?. 2 <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT S�RVICES <br />3200 CEbAR STREET, EVERET7, WA o8201 <br />425-257-8810 - FAY.425-257•9857—www,everell�va.org <br />APPLICATIONS ARE ACC�P7E0 FROM 8 AM 70 4 PM <br />R nn�iL l�r �/ �1gZ0.3 <br />PROJECT ADDRES <br />Owner <br />Te�ant <br />Eleclri�al COnlractOr <br />. C�1�N�aMN9ol(� <br />Stato L�censc Number <br />Propospd Use ot Bwldmg <br />Mail Aatlress <br />Mail Atlarese <br />Mail Addr099 <br />Description ot Work to Be Done: 1 i'�S� � 1 <br />NOTG: WIRING IN NON-DWELUNGS IS REQUIRED 70 <br />BE IN RAC�WAYS, MC ORAC CAf3LE, <br />CITY OF EVEfiETT LOCAL SALES T�X CODE IS 3706 <br />Gry <br />Ciry <br />Cily <br />l0� :�0-i j <br />C-i�lD�� <br />SIBlC/Zip <br />Sieterzip <br />SldtelZip <br />w <br />25p <br />COMract Pricc ol Work <br />Contac[Petson (PlunReview) <br />� �U <br />/ heroby cortiry fhnf ! have road and eaaminod fhis �pplica(iyn and know fho same fo be frur� and <br />cormcl All prowsions o! laws and ortlirrantes govemmq th�s fypo o! work will be conrpleted <br />whefher specdied herein or noL 7hu qian6np ol a permrt dnr.s not �esuirro to �l�e nufhonrylo <br />vlolare or canco/ fhe pruvisions o/ any n�hor sfafo oi locol IowroguPtin,ry conslrvcGon or Ihe <br />ponormance olconsWc6on. Thaf i am aurhorized by fhe owner ol tnis property ro pedorm fhe <br />�+�ork lor wh�ch oppiicalion is rnade and I comp/y wdh fhe Sfale Con(rncfors Law 1ti 77 RCW anrl <br />29G 200 WAC. <br />S�gnatura <br />Pnone <br />Phonc <br />Phon� <br />FF.E <br />�i �l0 ^ 2s� <br />