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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 3-- // fD <br />425-257-8810 - FAX425-257-@857—www.everettwa.org �/0�3-06(G <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />l <br />1510 S� E�E�� MAIL WI��I <br />PROJECTADDRESS �D tC7 �i� I I MACL- (.U'Ay <br />�J�� U,J/1 q 8208 � <br />I—� �T�C�i — Co �E ��DG � (.,�= 4� - ba9 -b9ao <br />owncr <br />Mail Address <br />Cily <br />Tenanl Mail Address City <br />�q�GT�ic E(�cr �IC Zn%� 21307 67t"� Jt, l�% <br />Electrical CuNraclor Mall Address City <br />��EcT�� 2��8 M N �. '/3i�10 <br />Slale License Number <br />Praposed Use of Buildinc� <br />Doscriphon of Work to De Done: I ��� <br />NOTE: WIRING IN NON-DINELLINGS IS REQUIRED TO <br />BE IN RACEWAYS, MC OR AC CABLE. <br />Slale/Zip <br />Slale/Zip <br />c y�n�a� � 03� <br />Slate/Zip <br />Cuniracl Price of N ork <br />Conlact Person (Plan Review) <br />l� <br />CITY OF EVERE'fT LOCAL SAIES TAX CODE �5 3105 <br />1 hereby certify thaf 1 have read and exarninod this application and know fhe sarne fo be frue and <br />correcL All provisions of laws and ordinances goveminc� fhis typo ol work u�ill be complefed <br />u�hether specified herein or noL The gronting o/ a pernuf does nof presume to give aufhonty to <br />violafe or cancel the provisions o( an}� other sfafe or lecal law rec�ulo(ing consfruction or the <br />perfortnance o( construcfion. That 1 rn aafhonzed by the owner ol this propert}• fo per/omi the <br />work lor �ylJich application ispiade nd 1 cornp��vifh the State Contracfors Lnw 18.27 RCW and <br />��fl--lo <br />Phone <br />Phanc �} <br />a2�-� i, <br />Phone ' <br />FEE <br />� I �\j �� � O�L� <br />