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ELECTRICAi. rE��!!!T �-lPPL�CA►'i"iON <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — v,n�nv.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />��,:, -7 �l `-_.t- ;' (— <br />I�ilc� c� 7 El��,�--���iz��-F INI'✓T(�, ��,�asl� IL��t�lti,- �(i�.:�1���ti�.� �� <br />PROJECT ADDRESS <br />Owner <br />Tenant <br />v����� <br />Electrical ( <br />o � ��t�ted i- <br />hlail Address <br />Mail Address <br />L-1� �-1 i'� L <br />�c��� �c�l�lti� <br />ile License Nmnber <br />Mail Address <br />�t_-R � 1 +- <br />Cily <br />Ciry <br />( IOo r������� r���cr i� �� <br />Proposed Use of F3uildin� <br />�—� / <br />Descnption of Work to Be Done: ��� <br />NOTE 4VIRRJG IN NON-DWELLINGS IS REQUIRED TO <br />BE IN RACEWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1; �'� . <br />Sla�elZip Phone <br />Slalc.7ip Phone <br />L/ZS <br />1�L-�L4-i- 3zz���oo <br />Cily � StalelZip Phonc <br />� 2 Lco � `� <br />, <br />Coniracl Price o( Work <br />Conlact Person (Plan Review) <br />C� Y-�'/� ��-U.��✓� �'ONs�;����,U� <br />1 he�eby certify fhat I have read and examined this applc�tion ar;d knav fhe same to be frue and <br />correcL All provisions o/laws and ordinances govenwiy this lype o/ �vo�k �vill be cornpluted <br />whefher specdied herein or not. The pranfing c/ a perml does not resume fo give aufhority fo <br />violate or cance! Ihe provisions olany ofher sfate nr localla�v repuPtin� consht�c6on or fhe <br />perfomiance o! consirvcfion. Thal I am aufhorized Dy the otrner ol this property to peAorm the <br />work lor �vhir,h appucalion is niade ond I compty �rith the State Confrnctors Law 1827 RCW and <br />296.200 IVAC. <br />E�Sr�S-o63 <br />FEE <br />I <br />