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ELECTRICAL PERMIT APPLICATIOf� <br />CITY OF EVERt7T PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS AP.E ACCEPTED FROM 8 AM TO 4 PM <br />� , '� <br />._v`c�'�� /���F/•'J+� �C�Sj�C��).S <br />PROJECT ADDRESS <br />owner <br />Tenant <br />�dail Address <br />Mail Address <br />City <br />Cily <br />StatelZip <br />Stale2ip <br />r�i,o�� <br />Phone <br />oY,c'��%���--���r,t�P. /l/� j 5%��'% �ir/�f LC.riv 95��9/ �6� .SL�' <br />Eleclrical CoNraClor M11ail Address Ci1y Slale2ip Phone <br />�t/'G%E� ;�l-S� �E �( ��-d � <br />Slate License Num6er Contracl Price of Work <br />� C.7i �'Le�q 1 S � /�!'i� X /[��ii <br />Proposed Use of Buildinc� Conlacl Person (Plan Re��iew) <br />Description of Work lo Be Done: <br />NOTE: W IRING IN NON-DW ELLINGS IS R[QUIRED TO <br />BE IN RACEWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ce�tily tfraf I Imve read and examined fhis applica(ion and kno�v the same to 6e tn�e and <br />conec(. All pravisions ollaws and o�dinances governing thrs type oI wod< will be cornpleted <br />whefher speciGed he�ein or not The grantinc� ol a pemut Aoes not resurne to give authority to <br />violafe or cancel Ihe rovisions o/any other sfate or local latv iec�uP!in� const�uction or the <br />peilonnance o( ca rctia That 1 am authorized 6y the o�vner of this propr.rty to pedorm fhe <br />n'ork (or a�hich applic lion is � ade and 1 conrpty wi(h the Stale Contracfors Law 18.27 RC W and <br />296.200 WAC. <br />,'.. <br />/ /=��%�' ` � �---r � �i /4�� <br />�Sigi Iur� Dale <br />FEE <br />i <br />��;!� <br />L' � � � ` <br />