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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, Wq gg2p1 <br />425-257-8810 - FAX 425-257-8857 — www,everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />9(�Id�S 2����2 A�E <br />PROJECT ADDRESS <br />S�V 1CrN <br />owner <br />S A�,� <br />Tenanl <br />Electrical Conlraclor <br />Slate License Number <br />Mail Address <br />Mail Adtlress <br />Mail Address <br />�1.1-�1�E ��Rti�./�2`1� <br />Proposed Use of Bmldmg — <br />Description of Work �o Be Done: CC�-A�vG-E <br />�'-' l'c� �Y'-o V,.t_�� Z Wrr <br />__� <br />`�t�'ia2/�-SE UT-i ���ru C i 2 r...n <br />�E <br />EVGz� lnff�- �tFzo3 "�Z� <br />City Slate/Zip <br />c�iy s���az�� <br />City State/Zip — <br />Contract Price of Work <br />�-1 FN <br />Tb LCY� LoA <br />NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO <br />BE IN RACEWAYS, MC OR AC CABLE. <br />�c-���y S� <br />Conlact Person (Plan Review) <br />�, � <br />TRa� � ut L <br />FEE <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certrly tha( I have read and examined this application and kno�v (he sarne to be true and <br />cor�ect. All provisians o/ laws and ordinanccs govcrnmg (his type oI work �vill be completed <br />�vhe(her specilied herein or noL The yranting ol a pemut daes not presume �o give au(hority fo <br />per/o n ar ce�o/ co/ � sfrucGon n That I am ���uthonzed by f�ie �o� �ie �ol Ihis pro�erty to pe or�m Ihe <br />wo�k lor which applicaBon is made and I comply �vifh fhe State Confracfors Law 18.27 RCW and <br />296.200 WAC. <br />� <br />:� - ' .__� � J l2' o � <br />Signawrc ate I — <br />Phone <br />Phono <br />Phonc <br />