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r <br />ELECTRICAL PERMiT �4PPLICAT'ION <br />CITY OF EVER�TT PcRMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257•8857 - wwv�.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />c� <br />y <br />� <br />/ `['� �' /, c/ '� �l-i- L ( � <br />PROJECT ADDRESS <br />1Q Pr�,v� <br />Owner <br />Tenant <br />A1ail Address <br />Mail Address <br />Ciry <br />City <br />State2ip <br />Statc/Zip <br />Phane <br />Phone <br />3 L• L' <br />L•'/=i L�i i' L/,"<-- y'= /i /�c-f= Z�>% iE S�tlDif�'c//�.�✓ .2'iJ Y,t=2 IL�c'<'ii 1� <br />Electrical Conlraclor Mail AtlAress Clry State2ip Phone <br />/'i_JC��/;.' � IsG <br />State License Number <br />/ -/ <br />Fropused Use of 9uildinp <br />Cescription of WorK to Bv Dore: /_' _- �% ��, <br />Contract Prce of bl,brk <br />Contact Person (Plan Review) <br />�-','i'.� � :-'/'L <br />1'f::ur-=� .�f.Vr7 G �y /.'r.Ll �- ,_-.'/ !//-, <br />_., �� -� <br />'..t � — ri / D !c7 ii' L: . <br />NOTE: WIRING IN NON-DWELLINGS IS RE�UIRED TO <br />BE IN RACEWAYS, MC OR AC CABLE <br />CITY OF EVERETi' LOCAL SALES TAX COOE IS 3105 <br />I hereby certify th,at I ha� � iead and examined:his applicafion ana know fhe smne fo 6e lrue and <br />re�recf. All provisicns ollaws and ordinances govemmg fhis type olwerk �vdl be completed <br />•.vnether specdied herein or not. 1'he ;7ranting o/ a permd dces nof resume to give autherity fo <br />✓iola(e or esncel the provisions of an y other sfate or local law reguPtmg consWction or the <br />performance of ccostruchon. Thaf I am authonzed by the owner o/ this properiy to peAerm the <br />�vork �cr �vhich applicatien is roade and 1 ccmply wilh ihe State Confrac;crs Law 18.27 RCW and <br />296200 WAC. <br />� <br />V"' <br />�. .�._ <br />�'----5lqnature�• <br />_ i <br />- ------ /� .�� -- , /c <br />FEE <br />� <br />/ � � <br />�v�, i� -1��� _> <br />