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ELECTRICAL PERMIT APPLICATIUN <br />CITY OF EVERETT PERMIT SEI�VlCES <br />3200 CEDAR STREET, EVERETi', WA H8201 <br />425-257-8810 - FAX 425-257-8857 — www.everellwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />�� � �� �'l ��li �1�„'.� �,ve�-�.H �✓/� 1�2�� <br />PROJECT ADDRESS <br />= � j <br />�[ 'I�'1(t � <br />Owner <br />Tenanl <br />� ��'/lt;)t <br />Electrical Conlraclor <br />'�i�- l`��'� 1�.�611 <br />Mail Addross <br />Mail Addross <br />/K�•l �ll�'l�Ui� <br />Mail Address , <br />Stale Liconse Number <br />CC�f <br />(� - � CC L�, {'i �(. � w' <br />Proposed U�e bf �uildidg <br />Description of Work l0 6e Done: <br />Li iLi�," <br />� <br />NOTE: W IRING IN NO�J-D�VELLINGS IS REQUIRED TO <br />BE IN RACEWFlYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby catily that 1 have rend and examined fhis applic� <br />r,orrrct All pra��isions ollaws and ordinances �oveminc� <br />�rhefher speciGed herein ornoL The grantin� ol a pernuf <br />violafe or cancel the provisions ol any ofher sfate or locol <br />per(onnance oI consfrYiction. That I am authoiized by (hc <br />�vork tor which applicafion is rnade and 1 comply with the <br />296.200 4l�AC. <br />' / ��,'� 1`r , ���,i✓C,.,, <br />Cily <br />Cily <br />City <br />V, <br />vitic�t i�;� �i�f <br />Slalo/Zip <br />Slale/Zip <br />✓ f:i f�� �.. ,� c <br />Slalc/Zip <br />`! t S� 1`!y <br />Phone <br />Phono <br />�L�� ''y z�" �1yv-u4��> y <br />Phone <br />Conlract Price o( Work <br />��c �hn ; (��l!Iv�� i `Yii"�LyY�u( <br />Conlacl Person (Plan Review) <br />r� <br />�n and kno�v fhe same fo be 6ue anA <br />s 1}�pe o( u•ork will6e cornpleted <br />res not presume to gice authority �o <br />�v regu/ntinc� construcfion or the <br />,rner o/ fhis properiy (o peAoim the <br />�te Contracfors La�v 18.27 RCW and <br />�r <br />Ci D <br />FEE <br />C � l�li� ��p' <br />