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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8P57 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />8 7� z � {�L S.� <br />PROJECT ADDRESS <br />yzs <br />Owne�M�-, �,�" � y.�i .�r-�t- A��. s� ���Y�.zs� �� 9��x 3� : <br />Mail Address Cily Slale2ip Phone <br />1..����orcl /rl�rHer �70z S��`'Pl SE �uu-� GrJA 9Xw9 �'zs 710-�/0/ <br />Tenanl A1ail Address City Statc2ip Phonc <br />� <br />M11ail Address <br />�G��(/,}r c �6 z- k �o <br />Slate License Num6er <br />ks�d���� <br />Propas d Use of Building <br />Descriplion of Work lo Be Done: <br />NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO <br />B[ IN RACEWAYS, MC OR AC CA�LE. <br />CITY OF EVBRETT LOC:�,L SAL[S TAX CODE IS 3105 <br />Cily <br />y'.45 <br />Slala2p <br />SDU <br />Conlracl Pri;e of Work <br />Conlacl Person (Plan Review) <br />I hereby cerLfy Umf 1 have read nnJ eaamined fhis application and know fhe same fo be tnie and <br />correcL All piovisions ol/a�vs and ordmances c�ovenring fhis lypc ol �vork will be complef�d <br />nhefher specJiaAherein ornoL Tl:e granfing o/ a permrt does not resume fo give aufho�ity fo <br />violate urcancel fhe provisions o(any ofher sfafe er locallaw reguPtinc� construcfion or Uie <br />peAonnance o( consfrucfion. Thaf 1 arn authonzed by the owner ol Ihis property fo perfonn the <br />worh for wNich applicafion is rnade and 1 comp/y with the State Confractors Law 1827 RCW' and <br />296.200 IVAC. <br />� ��ti_ 3���7 <br />lgnalur Dale � <br />FEE <br />Phone <br />�=v�c7 u5 4- <br />