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ELECTRICAL PERMIT APPLICAI'ION <br /> CITY OF EVERET�' 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 /> ���iJ�� �K.� �"`��L— .:7� �---_•'�'T'"-ILL . <br /> PROJECT ADDRESS <br /> ��- � -;>� , � �� .U\.i,1�� �5 �>>�T-=' <br /> Own2� h9ail AUdress Gity Stato,'Zip Phone <br /> Tenant M11aii Address Cip� State.'Zip Phone <br /> _��.�fl�—�l� �.n��_: �LCG ��K�� U-i�-���.�y- `�Uo W��$:�i� �-fL��3���_� :��:� <br /> Elecirical CoMraclor Mail Address City State/Zip Phone <br /> _ .�1 _� =, <br /> `_�cc_C,�.i:_e_ \�l1 ' -'r` " <br /> Slale Licensc Numbcr Contracl Price o11��ork <br /> �_ �� �" <br /> Proposed Use of 6uildin9 Conlact Person (Plan Review) <br /> Description uf Work to 6c Done�. ' ����� �'�.. .� 1J����.> � `�� <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> �E IN RACEWAYS, MC OR AC CAf3LE. <br /> CITY OF EV[RETT LOCAL SALES TAX CO�E IS 3105 <br /> I hereby certily Ihat 1 ha��e read and examined lliis applicotion end know the sante fo be fnie and <br /> corred. All provisions ollaws and ordinances oovemmg fhis fype ol�rork�rill be cemplefed <br /> �•rhether speaGcd herein or noL The granfing of a pemuf does not presume fo give authonfy to <br /> violale or cancellhe provisiens o/any olher state or local law regu/afing construcLon or the <br /> perfomiance o/consfruction. Thaf!arri aufhonzed by Ihe o�rner ol this properiy lo perlenn the <br /> i+-orF Ior which application is made and 1 comply�rith Ihe Sfafe Confracfors Law f 827 RCSN and <br /> 296.200 WAC. <br /> � � <br /> �.'`.�. . '�,-- - --C-- Z—� �—��� <br /> ��� Signalure Date <br /> �c,�d� � -/D$ <br />