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i - - - - --- --- -- - <br /> I ELECTRICAL PERMIT APPLICATION <br /> � CITY OF EVERETT PERMIT SERVICES <br /> i 3200 CEDAR STREET, EVERETr, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —�.vww.everettwa.org <br /> � APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> ' ;, �21 IS-r �� <br /> PROJECT ADDRESS I <br /> l-�XEi /���5� <br /> Owner Mail Address Ciry State�Zip Phone <br /> Tenant Mail Address City Slate/Zip Phone <br /> �c 1 [i ('n-��t �Ni, (�2p� 2�I;�r �' nil,.l 5�7�ni� �-� D l,.J'� �i`bi`i7, �-!Z5 s�s 5�9 I <br /> Eleclrical Conlraclor Mail�ddress City StatelZip Phone <br /> `_;u rn+r�lE,i ca�� �L �'i �-�oU - <br /> Stale License Number Contract Price of Work <br /> S� I� <br /> Proposed Use of�uilding Contacl Person (Plan Review) <br /> � � r <br /> ��.�()d—� .—�7� <br /> Square Foolage(If re9idenlial nev+cons�rur.tion,remodel or addi�ion) <br /> � <br /> Description o(Work to De Done: ��..] � ��N t� 1T��I � � �U� S� �• <br /> I <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE � <br /> �, BE IN RACEWAYS, MC OR AC CABLE. C��O� I <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I Acreby curiily lhat I have read and exmnined fl�is applicafion mid knor�(he sanre to be Inie and y � �?1� � � � <br /> � r,oner.t All provisions o(laws and ordinances governing(his fype o(�vodc�rill be completed _ , l/ , _ <br /> iirhe(herspecilied herein ornoL The granhng o/a pernut does not pr�esurne to give aufhonty to <br /> violate or cancel fhe provisions ol any ofher state or focalla�v iegulaLng construchon orthe <br /> per/orniance ol constniction. That I anr aufhorized by fhe owner o/fhis �roperfy to pedomi the <br /> r;ork lor which application is made and I comply�rifh(he Stafe Contrac�ors La�v 18.27 RCW and <br /> � 296200 WAC. <br /> I <br /> i <br /> � '� - I - I � i <br /> ". - SignaWre � Date j <br /> � .—- _—__. _._-___J <br />