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ELECTRICAL PERi�IT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICFS <br /> 3200 CEDAR STREET, EVERETi', WA 98201 <br /> 425-257-8810 - FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM c�l �� �6 <br /> 0 <br /> ' �i � '�_ � l� ('i� c v �c� � (',,,c <br /> PROJECT ADDRESS <br /> M �� S Pss � c � ���-` 5 LLL <br /> Owner A1ail Address Cily Stale/Zip Phonc <br /> f "\ �C11.�� � �L� /- ` \��j--� <br /> Tenanl A1ail Address Cily State/Zip Phone <br /> �`�e�,r �� � o S.-.� S �5 �`' �G� � �c�..0 �t �-oG 3 �v-Gy.1� <br /> Eleclrical Contractor A1ail Address Cily Slate/Zip Phone <br /> L �. c- �i C�S. vb�� �� �a� s�a <br /> Slale License Number Conlracl Pnce of Work <br /> l�.� � � �, U S � <br /> Proposed Use o(Buildin� Conlact Person (Plan Review) <br /> Descriplion o(Work lo �c Done: �� L L��C_- � �-��"� �- C'_ <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> !hereby certily Niat 1 have read and examined fhis applicntion and know fhe same te be Irue and <br /> correct. AN provisions olla�vs and ordinances goveming this type ol�rork .vill be complefed (� Q 6 p }���Z- <br /> whether specified herein or noL The granfing ol a penruf does nof resume to give aufhonty fo <br /> violate or cancel the provisions ol any ofher state or local law reguPting consfruchon or the <br /> perfomiance o(conslnrcfion. That 1 am aufhonzed by fhe o�vner o/fhis propert}�to pedom�fhe <br /> �vork lor�vhich application is made and 1 comply�vilh fhe Stafe Contracrors Law 1827 RCW and <br /> 296.200 WAC. � <br /> � ��_��j � � <br /> -% i'/�i' 6 s� -� � - G6 <br /> Si naWie Date <br />