Laserfiche WebLink
ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERIVIIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - �r �.v.everettwa.orq <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /><I,��] C{ ',r; ���. 5��. <br />PROJECT ADDRESS <br />Owner <br />Tenan� <br />.-� s ��.z� q <br />A1ail Adtlress <br />MailAddress <br />City <br />Cily <br />la -��—�% <br />�a7 � 2 —la5 <br />�( ���% g <br />Slate/Zip <br />S1ate2ip <br />Phone <br />Phonc <br />_ ., <br />> <br />�� ti�rv��r ��et_ 1��� �J<�� I Y2Z /�{�izrSG;;�/� lN/� �b'Z�O Cy�J�87a -/o <br />Eleclrical ConUactor Mail Aatlress Cily Slate/Zip Phone <br />� ���vru r � �ll�� <s i3 <br />Slale License Number <br />J� �r���t 'iAC <br />�... <br />Proposed U ;e of Buildinc� <br />-� 3D�� c� o <br />Conlract Price of WorY. <br />Conlacl Person (Plan Review) <br />( `;� 7 /� <br />Descriplion of Worlc lo Be Done: I�C�' �� �` �� S'�6` �!/7C wi il e A �� �1.� r—C)(Z ,l//%Cc' <br />I >>i�� �� �/� <br />NOTE: bNIRING IN NON-DW[LLINGS IS REQUIRED TO <br />BE IN RACEWAYS, MC OR AC CAB�E. <br />CITY OF EVERETT LOCAL SALES TA.K �ODB IS 3105 <br />1 here6y certi(}� (hat I have road and examireAlhis applicafion and kno�v fhe same to be true and <br />conecl. All provrsions ollaws �:nd oidinances �oveming this t}�pe ot �vork �vill be cornpleted <br />whefher speaGed herein or noL The ,qranfing o/a pern rt dues not presurne to �ive aufhor�ry fo <br />violafe or cancel fhe provisions o/any other sfate or loc �I law re�u/aling construcCon or the <br />peilormance o/ const�ucfion. That I arn authorized by 6 i� owner ol fh�s propert}� fo peAonn (he <br />work lor which applicalion is made and I cornply �rith the Sfafe Contracfors Law 78.27 RCW and <br />29& 200 WAC. � <br />FEE <br />i <br />�-,:,� -- �' I Z -.2/- 2C��• i �'-, <br />Signaturc Date - , . <br />