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ELECTRICAL PERMIT APPLlCATION <br /> CITY OF EVERETT PERMIT SFRVICES <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 � '�—p�.p6 <br /> C06/z -D /� <br /> �r✓, . � � <br /> ��l �� ri � %I /I�`-%. ./��' �/� ��'`" // <br /> PROJECT ADDRESS Y�� �y� ��� <br /> -�nl��, ) C�r;v; v��:'/ c;��,�' / /ti/!'C'i;ji��'�{) ��;:/ r_,:'U f ��7�� �„�0.5 <br /> Ownc� —� lail Address City Slnle/Zip Phone <br /> Tenanl Moil Address City Stale2ip Phone <br /> li�//y 1�'/ �� f-,� �� <br /> Eleclrical Conlraclor Mail Address City Slate/Zin Phone <br /> Stale License Number Contract Price ol Work <br /> i /� <br /> /:A'��P> ✓�',uiS/'i'C' lll <br /> Proposed Use o(Bu�Hing Contact Person (Plan Review) <br /> �✓r� � <br /> Descriplion o(Work to 6e Done: / � ��/ � � / "��/n/ �r�- ��'Y — <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 heieby certilp fhat 1 have read and exarnined fhis application m�d kno�v Ihe same to be Vuu and <br /> correct. All provisions olla�vs and ordinances governmg this type of�vork will be cornpleted <br /> �thefl�er specibed herein or noL The granfin�o/a penmt does nu(presume to git�e aothority lo <br /> violafe or cancel fhe provisions olany other sfafe or local law regu/ating construc6on or fhe <br /> peiformance o�cons(ruction. That I am aulhonzeAby fha o�vner o/fh�s property to pedorm the <br /> work lo��vhich applicatien is made and I comply�vith the Sfate Confractors Law 18.27 RCIN and <br /> 296 200 WAC. <br /> � ,1 ' %C - J- (�� <br /> i�, ,� /1;.. � <br /> � ignatu Date <br /> � J,lJln la -G( 7 <br />