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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES 8-�S,o S <br /> 3200 CEDAR STREET, EVERETT, WA 98201 L p�j g_I S Z <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT &CREDIT CARDS ARE NOT ACCEPTED <br /> /�ov Z i—' �1�1/3���/.�E Vw DI'� <br /> PROJECT ADDRESS <br /> /f c�L2J!/_ ,f�/�1 h� C�12�=.L/�f <br /> Owner Mail Address City State2ip Phone <br /> Tenanl �!�il Address City Slate2ip Phone <br /> M� ��tii = c�cirvC �10 i�'� <br /> ElecUical Conlracl r Mail Address Cily StateRip Phone <br /> i�r � � i� r- coo � � J <br /> State License Number Conlracl Price of Work <br /> �=S/'.c2,��S rl Sfi9N� <br /> Proposed Use of Building Conlacl Person (Plan Review) <br /> Description of Work to Be Done: / -� �1����/ C�/Z L L//j <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. j � o, <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 here6y cer7ify fhat 1 have read and examined fhis application and kno�v the same to be tnie and <br /> correct. All provisions o/laws and ordinances governmg this lype of�vork�vill be completed <br /> �rhelher specilied herein or��oL The grenting oI a pennd does not resume to give authonfy fo <br /> violafe or cancel(he provisions o/any ofher stafe or local law reguPatine�construchon or the <br /> performanr.e o/construction. That I am authorized by fhe owner o/fhis propeAy fo peAorm the <br /> u�ork for�vhich applicafion is made and 1 comply�vifh the Sfate L�ntracfors La�v 18.27 RCW and <br /> 296.200 WAC. <br /> �i�:���'� 8 - z 3 - � S <br /> , i�nalure '�] � Dale <br /> � <br /> _ ' � �_ ` <br /> _ ti <br />