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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <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 <br /> � <br /> ,���?�l �1 ,�� `'�� - <br /> PROJECT ADDRESS <br /> Owner �7ail Adtlress City 5tate2ip Phone <br /> 1 <br /> `�?1�Z �a��rx-1 io,-, I I`i-�j C�n,��'1z� �11�k�'�-� �q `lc�-5 �la�.�'s���18 <br /> Tenanl Mail Addiesc -� City StatelZip Phone <br /> i I� �f� Pc-{i�L �1,'1� , ��. ���x ���� �4YT'1c�Y� 1i.Y'� 7�� 5�7 ����0� <br /> [leclric�l Contraclor Mail Address City State2ip Phone <br /> I� 'L ELE�� �� ' ' _ �'_���o <br /> Slale License Number Contract Frice of Work <br /> C-�S�C� 1Co <br /> Proposed Use o(Building Conlact Person (Plan Review) <br /> c <br /> Descriplion of Work lo Be Done: � ������'�'��C� C.ifC�='�t� �cii��q�e� ��� (/�Q <br /> _-r-i,aa-. �t .3�.. C-;i-t� d��Ccx `�cc��=.c('cS c !��d�r- .��, �c ( <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. �� <br /> � <br /> CITY OF EVERETT LOCAL SALES TAX COD[IS 3105 <br /> 1 hereby certily that I have read and examined fhis application and h�7o�v fhe same m be true and <br /> correcf. All provisions o//au�s and ordinances goveming this fype oI work will be cornplefed <br /> whefher specilied herein or noL The granfing o/a permd does not resume to yive aufhonty to <br /> viola(e or cancel Ihe provisions oI any ofher stale or local la�v reguPfing construction or fhe <br /> peiformance o�consf�uc6on. Thaf I am aufhonzed by the owner o/fhis property fo peAomi the <br /> work lor which applicafion is made and 1 cg�ripl}�wilh Ihe State Contractors Law 78.27 RCW and <br /> 2 00 WAC. ) <br /> � �' �'' � <br /> � <br /> ;��- Q��,�,; ��r�4, �a ���'C- l .� l <br /> SignaWr�+ Date <br />