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ELECTRICAL PERMIT API�LICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org � Z—/7—�� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �5• <br /> � U71 Z — <br /> �� 3�� �� �-�Nt�=��'�. ���t�1= <br /> PROJECT ADDRESS <br /> OWner Nall i.udress GIq StateiZip Phone <br /> Ten�nl p.i�ll Addiess Qty StaielZip phone <br /> �� ���:1 1� � � <br /> EleCtriCal Conifaclof tdoil Address City State/Zip Phone <br /> ��� �,���:�� �(�( k(' 3�,� � <br /> State License Number Contract Price of Work <br /> ����� � <br /> Froposed Use of Building Conlacl Person (Plan Review) <br /> Description of Work lo Be Done: l�(.�G�12( (J�'(, l Ir�l: '� �w "��—� w��—�(� �ti <br /> �S(L��J (^U1J � _ <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I !hereby ceriil}�(haf 1 have read and examined this appli�ation and kr.o�v the same to be Vue anA <br /> correct. All pruvisions o//aws and ordinances governmg fhis type ol work will be campleted <br /> �vhether specitied herein or noL The grantin,q ola permd does not �resume to give aufhority fo <br /> violate or cancel the provisions olany other slate or local la�v reguf�ting consVuction or fhe <br /> perforrnance o/conslruction. That 1 am autborized Gy fhe owner o/this property fo peAorm fhe <br /> �vork lor�vhich application is made and 1 compfy with Ihe Sfafe Confractors La�v 18.27 RCW and <br /> 296200 WAC. <br /> � , � <br /> � <br /> ' �' ,� <br /> / <br /> i '; C' � i, ,?�-�, ; �� -l �-��- .���� _ c�s <br /> Signaturc � Dale � <br />