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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERFTT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everellwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> C% �f� � I l �� 5(i� (� <br /> � <br /> PROJECT ADDRESS <br /> ` �( /�, //lI// t , //�!�7/� ` <br /> J ,! `/ <br /> ��� SJ <br /> ` C'j 1,' + `, 1�^ "'ClVIILU}1 r YS'I'��'l�l w! • � J � `�; Cl(i <br /> Owner ldail Addross Ciry Slale2ip Phone <br /> i <br /> �c L�R�Lq, - <br /> Tenanl A1ail Address Cily Slale2ip Phone <br /> !'.����l �L��'�7 <br /> J�c����c' � �1���!`r t= s�2 S-��O lV� /�-r(,'��,�z,� Grl� `�.,2:� 3 � �9-S` 3lF <br /> Eleclrical Contraclor Maii Address Ciry S�ate2�p Phone <br /> ��/1 �1,��) j�� `�S���t ��l ��C�c�..-_ <br /> Stale License Number Contracl Prico of Work <br /> � � �� <br /> Proposed Use o(Building Conlacl Person (Plan Reeiew) <br /> l�t � << � = l��t��� � t« �z u� ;�,� ,� �t � <br /> Description o(Work lo Be Done: , <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> I CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> � <br /> iI l�ereby certily fh�f I liave read nnd examined fhis ap/�lication and kno�+'fhe sante to be lrue and �����I -G�� <br /> correct All p�ovisions o/la�vs and crdinances govenun�this type ol a•ork wil!be completed <br /> � rvhefher speaGed herein or not. The c�ranfinc�ol a permd daes not presunte to give aulhonty fo <br /> violafe or cancel tBe provisions olany olher s(afe orlocallaw mgulafing consWchon orthe <br /> perlomiance o�constiucfion. That I am nuthorized by fhe ouner o/this property fo pedenn the <br /> n-ork!or which application is made mid 1 comply�rith fhe Sfafe Cont�actors Laro 18.27 RCW and <br /> 29G.Z00 WAC. <br /> C �,���=�" y-/� - I ( <br /> - '�Signalure Uale <br />