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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR S-fREET, EVERETT, WA 98201 <br />a25-257-8810 - FAX 425-257-8857 — www.everetlwa.org <br />APPLI�ATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />�.°1��� '�l C I�� r� � V C r. (/i�k'_C �'� <br />PROJECT ADDRESS T�— <br />1 1 �-Fi,'NY <br />owner <br />Tenant <br />a�,:�,��F,� � <br />Eleclrical Contractor <br />�a 1� �� �a �v F s�, - z- P'� <br />Slate License Number <br />-� <br />f� �.`�� DF n�' ii\ <br />Proposed Usc ot Buildin9 <br />Mail Address <br />Mail Addmss <br />A1ail Address <br />City <br />"�n_�G� <br />,� "� -yl-/- �3= <br />State/Zip Phone <br />Cily StaiclZip Phone <br />���✓� � �-r Eo, w� �'aas <br />ay �r�,;,r��;co �C-�Ju.���i'�`n <br />City StateRip � <br />�as 7�`l �'�`; <br />f �� 1 L' C- `—'r' — <br />Contract Price cf Work <br />Contact Person jPlan Revieu�) <br />Descnption of Work lo Be Done: � � �' �/` � ( C "�` �R � E L U �i ( `�J � � (_ �— � <br />��G- A,��PCPF SY ��� <br />NOTE: W IRfNG IN NON-DW [L�INGS IS REQUIRED TO <br />B[ IN RACEWAYS. MC OR AC CABL�. <br />CITY UF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 heieby certily fhnf I havc reud and oxarnined this apqlicafon and kno�v the same to Ge trua and <br />r.onecL All pruvisions o/I��rs and o�dinances governmg (liis fype o/ rvork u�ill be cornpleted <br />u1m(her specdied heprein ar nu1. The c�ranLnc� o/ a perrnd doe, not presume lo give authonty te <br />ii��fomra�ce�olco'rutri�li�or�nTlaflem���u(fl�iizedbytlie�o�iie olfltisproperf}f�opeAOmt�tha <br />vork la� �vhich applicatbn is mad� and I comply �vith fhe S(ate Coniractors La�+� 18.27 RCLV and <br />29G.200 WAC. . <br />�� /. <br />������ ,� �� , <br />si na�um <br />_; ,� <br />FEE <br />