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ELECTRICAL PERMIT APPLiCATION <br />CITY OF EV�RETT PERMIT SERVICES V��� <br />3200 CEDAR STREET, EVERETT, WA 98201 � <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org � 0"7� 3—b�3 <br />APPI_ICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />�<���.� \I��"����\�t-, I��`� <br />PROJECT ADDR[SS <br />Owner <br />Tenant <br />�%'-� �� ����: � <br />Mail Address - <br />Mail �\uur �ss <br />UC L�-l�_t <br />City <br />City <br />�F!,f: � <br />Phone <br />Slate2ip Phonc <br />l: /. <br />�,�,;�-����,�� � rn r:�..,, � �� -ti� «����,�7 ��;A �rz� ����- ����r <br />[IecUical CoNreclor M11ail Address � 1 J����� �� City State2ip 2��-�� one �_ <br />' J �. <br />i"��``:. <br />�.� ly �. <br />� ��V i.= f -� (_ ��� <�: C� / r; h� _ % Q � O ��� C'� <br />State Liconse Number C�Nract Price of Work <br />���'��c�Cvlil C.� <br />Proposed Use ol Building <br />—� <br />� .) j-: <' c � `c ".> i l> � _:.�'7 /� ( <br />,� <br />'f.'::_'. ,. -_- (���A. 1��;,..�i <br />n <br />NOTE: WIRING IN NON-DWELLINGS IS REQUIR[D TO <br />BE IN RACE'JVAYS, MC OR AC CABLE. <br />Contacl Person (Plan Review) <br />zc��'.� �cc�< ��� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I ho�eby ceriily thal l have read and ezamined fhrs app6cation and know fhe �ame to be frue and <br />�:oneuL All provisons o/laws and ordinonc^s govr.rning fhis type ol �vork wi9 6e comp/eted <br />r�hefher spaaGed hercin or noL The granfin� o/ a pernuf does not resimie to �ive aufhonfy to <br />wolafe or cancei the provisions oI any other sfate or local law rer7uPfing construction or Ihe <br />pedornrance o/construcfion. Thaf ! am aulhorized by the otvner ol this property fo peAom� fhe <br />work lor �rhic + t�pplicafion is ntade and 1 comply nith the Slafe Contrncfors Le�v 18.27 RCW and <br />29&200WA : <br />` ' � � � r_.,/� . � <br />i � `�.Y� r (-l�-, i � .i . ,�.--�—� [�,�--------- <br />Y - Signalure Datc <br />FEE <br />�� 1��� <br />� � <br />)� <br />