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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERE7T, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> //� �1 � � � ��.i �� <br /> PR JECT ADDRESS <br /> �.{,) � ��; �/� `� C / � � �-��l?�- ��—j= /�P�"t' (��A 1�� <br /> Owner % hlail Address City Slate/Zip Phone <br /> �,LJ� <br /> Tenanl MailAdd:ess Ciry StatelZip Phone <br /> ZS-�-1.z2 SY3j <br /> r� !� <br /> �—�, ! ,( �i�r.<< f.� i: � j/</{ �;=Y�'c�" SCr� _ �q,C�.=ukw�—�. ,N .9�'y;� <br /> Elecirical Conlraclor M1tail Address City State/Zip Phone <br /> �=�< i i ��s ;--.�-? ��' <br /> S(ate License Number Contrecl Price o(Work <br /> Proposed Use of Building Contacl Person (Plan Review) <br /> .� r�� �� �� <br /> Descriplion of Work lo Be Done: ��� , i,�-. , .` �.�,,�., � {;y r � � ] C (� <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT IOCAL SALES TAX CODE IS 3105 <br /> 1 hereby certily Ihal I have read and ezarnined fhis.�pplicafion and knoiv(he same to be true and <br /> conec(. All provisions o/la�+�s and ortlinances governmg this type oI work�vill be complefed <br /> whefh�r speulied herein or noL TI�e grmifing o/a pernut does not resunte to give au(honty fo <br /> violate or cancel fhe provisions olany other stafe or local law reguPfing consfruction or fhe <br /> pedonnance olconsfruction. Thaf 1 am authorized by the on�ner o(this property fo perfomi fhe <br /> work Iar�vhich applicatian is maAe and 1 compty�vith thu Sfafe Conlracfors La�v 1827 RCW and <br /> 296.200 WAC. <br /> � . <br /> _ . �: � ,�i'�,:.� �� � S'r-�� <br /> � SignaW e�' E' ' Date <br /> � ' E o�io5- 19z <br />