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� <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />; 4� ' />,, <br />� ' <br />.L � �- �l%�V�Y�! L ( I�'��' <br />PROJECT ADDRESS <br />+ti <br />Tenant <br />Electrical Conlraclor <br />Slale License Number <br />� <br />A7ail Address <br />Mail Address <br />Mail Address <br />)�:t!�;►��tt ��iv,� <br />CI�Y <br />Cily <br />Cily <br />Proposed Use of Building <br />Descriplion ol Work to Do Done: I�I C �!;' ` �- �� �' j L� � � 1`' <br />' _� ) .� � • .;-�-r Si-.: , �l � ��-! t-? f� i i r'� r.� _, 7 - i= <br />_ L r c, �-� T r�\ T2�J'. c'� %—t� � l41 �� +� /� �1,� � <br />,; N � � _ r .if � � � ,�..«...,t, t� � �., . .!_ .�C. <br />:`-,�-,_., -�. . .�c u,�.._.__._ �.... . �. ', ~' � <br />NOTE: WIRING IN NON-DW[LLINGS IS REQUIRED TO <br />BE IN RACEWAYS, MC OR AC CABLE. <br />i_ti� L�'��� <br />SlateRip <br />Stale/Zip <br />Stale/Zip <br />Contract Price of Work <br />�;C- `"l�' C ) 7� <br />`� ,�?��.1 <br />Phone <br />Contact Person (Plan Review) <br />Phone <br />Phone <br />�) .? ��-� �^� 5 K.� ( iC. <br />, C � <br />+ S�_� ;%"C_r/ /Uc-'1-v <br />�� �_Uu �, ijC r' Ci �J�C C TS <br />� C,Fc � , i�' �rYrZ't��) <br />FEE <br />CITY OF EVERETT LOCAL SALES TAl( CODE IS 3105 <br />I hweby certilv Ihat 1 have read and exarnined this application ond know the sairie fo be frue and <br />co�recl. All provisions ollaws and ordinances got�ernmg this fype o! �vork will be completed <br />whefher spec�f�ed heiein or nol. The c�ranting ol a pernut dues nof �resume fo give aufhonty fo <br />violate or cancel the pi�visions ol any ofher s(afe or local la�v regulating consVuction or the <br />oerfom�ance oI construclien. Thaf 1 am aufhenzed 6y the o�rner of this property fo perfemi Ihe <br />vork ler �rhich applicnfion is made <vid 1 comply �vith the Stafe Conf�actors Law 78.27RCW and <br />29G.200 IVAC. <br />�-%! � �—� \� - _ - � i � <br />ii' � - �' - �,� /. <br />Si���iature Date <br />L (,lsG<t—ClG <br />