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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 425-257-8857 — tvww.evereltwa.org <br />�U,��� <br />� <br />`� i ` <br />PROJECT ADDRESS <br />-- , <br />�--f;,C' <br />/ '('� " <br />Owner <br />Tenant <br />i� ���� �� <br />Eleclrical Conlraclor <br />Slale License Number <br />��� �� <br />Proposed Use of �uilding <br />APPLICATIONS ARE ACI;EPTED FROM 0 AM TO 4 PM <br />SJ �J i Lf � <br />:.� � --� �>(;� %�� <br />�� �, � <br />� �� <br />Idail Address <br />Mail Address <br />Mail Address <br />Description o( Work lo De Done: ���( � <br />� <br />�`'�'����� G'�� , � <br />�f�/.�✓,�� <br />= <br />City <br />�l� <br />NOT E: WIRING IN NON-DWELLINGS IS REQUIRED TO <br />DE IN RACEWAYS, MC OR AC CABLE. <br />Cily <br />,�� �� iy� <br />StaleJZip <br />Slate�Zip <br />Slale2ip <br />Conlract Prico of Work <br />Conlacl Person (Plan Review) <br />%%7� 1' << / �"O.L' C�JlU <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby certily that I Oace read and examined fhis application and know fhe same fo Ge true and <br />corirct. AN provisions o( /a�vs and erdinances governmg fhis type of �rork �i�ill be completed <br />n�heflrer speuGed hemin ornoL The yranling o/a pennd does nol )�resume to give aufhonty to <br />�iolate orcancel the provisiens of anv oiher sfafe or focal la�v re�ulating construction or the <br />perfomiance ol construcfion. That ! 5m autheiized by fhe owner ol Oiis property lo pedomi tho <br />work lor nhich epplicelion is made and f comply wiflr IAe Sfate Centracfors Law 18.27 RCIN end <br />296.200 L4'AC. <br />� � • <br />� � �, <br />, <br />�: � Sinnaluro Date <br />���'�v� <br />Phone <br />Phonc <br />Phone <br />FEE <br />7�`� <br />� I Z OL� - (�(� � <br />