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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETf, WA 96201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEP''ED FROM 8 AM TO 4 PM <br />�(,�, j";;�U��7�% I�d-c/ <br />PROJECT ADDRESS <br />� G% ��� <br />� <br />� � rY��r>„��1. / 6�a. �,�c �'�,s,t/ C���� �•�� 9��0/ y9U9 <br />Owner hlail Address Cily Slate2ip Phone <br />lenanl <br />� � ;:, <br />Eleclrical Conlracwr <br />Slale License Number <br />�, <br />�dail Address City <br />� ! , V,c�,�,�.;� �0�7 /✓.L�l�cu.a�.d <br />I' , ,� " ' � <br />,, ,,,.,,, <br />Proposed Use of 6uilding <br />Mail l�Jdress <br />:ity <br />Descriplion ol Work lo Be Done: �J �' O�' .�� �` �/ + Y_ P. V <br />NOT[: WIRING IN NON-DW[LLINGS IS R[QUIR[D TO <br />BE IN R/1C[WAYS, MC OR AC CADLE. <br />CITY OF EVER[TT LOCAL SALES TAX CODE �S 3105 <br />siaiaz�� <br />G�/� % � � <br />SWIe/Zip <br />Conlract Pricc of Work <br />�/f�c l.�C�.�' <br />Contacl Person (flan Review) <br />1 here6y certdy fhaf 1 have read and exarnined fhis applicntion and knou� Ihe same fo be Lue and <br />correct All prov�sions o/ lan�s and ordinances governmg fhis f}�pe o/ work irill be complefed <br />w'�ether speciGed herein or noL The �rt�nting ol a pernut does nof presurne to c�ive authon(y to <br />vi�lafe ur cancel fhc `�rovisions ol any other sfafe or local la�v re�ulafing construction or fhe <br />pedonnance ol construction. That 1 am authonzed by the owner oI fhis property fo pe�fonn fhe <br />u�orR Ior aHich application is made and f comply with Ihe Sfafe Contr��ctors La�v 1 fi.27 RCIh� and <br />29& 200 11'AC. <br />i � <br />i,� � -� ;,� , <br />V ` / � i ��� �� <br />FEE � <br />1- i:�• C. �1 -CQ'1 <br />��h�e <br />6� J._ <br />Phonc <br />