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ELECTRlCAL RERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERV�CES <br />3200 CEDAR STREET, EVERETT, V�A 98201 <br />425-257-8810 - FAX 425-257-a857 - www.everetrNa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />35i 5 ���K�f�.il�,r �iv�. <br />PROJECT ADDRESS <br />k A 16�; rt <br />Owner <br />N�� <br />Tenant <br />35�F r������f��� <br />Mail Address <br />Mail Address <br />, Cvzr�tf <br />C.iy <br />City <br />, <br />�.�tn� �r CIzcl�r�c �hv��� ���5'1 Nt I�rh Sfi <br />Electrical Conlractor A7ail �ddress Ciry <br />LItI�1DE�S`I`1fGc <br />Slate License Number <br />��,,�I� F�+m�l � <br />Proposc Use of Dwlding <br />DescripUon ol Work to Be Done: <br />� ri ( t- � �\�V I(; I��� Pit <br />NOTE: WIRING IN NON-DWELLINGS IS RE�UIRED TO <br />BE IN RACEWAYS, MC OR AC CABLE. <br />(.�:.�) <br />`j �S �c�i 750-5� � � <br />s�atcrzip Pnone <br />SIa�c2ip Phonc <br />�N t �1�A . `l �Y ooF; <br />Staiel ipr�:, y�'w--177'�ane <br />3��. oc� <br />Contracl Price of Work <br />K�'� t� h i n'l�tr; <br />Contacl Pe n (Plan Review) <br />n1v <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 herr.by certify fhat 1 have iead and exarnined (his application and hno�v the same to be true and <br />conect. All prov�s�ons o� la�:s and ordmances governmp fhis type o/ �:�ork �vill be cornpleled <br />whefhe� specdied herein or noL Thc 9ranfuig o/ a pennd Joes nof presume (o grve authanty fo <br />viola7e oi cancel lhe provisions ol any other sfafe or local law reoulafing construction or the <br />pe�fonnance o(cons(�uction. That 1 am aulhorized by the o�vne� o/ fhrs properiy (o peAonn the <br />�rork lor which applicallon rs made and I compty with the State Confractors La�v 78.27 RCLV and <br />29G 200 Ih�AC. � <br />,a.'C�I°��IL�1 '����°� <br />I <br />FEE I�K. C�C <br />I <br />��,�7 -�;�, <br />