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ELECTRICAL pERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES �o _as�, 5 <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everetriva.org �-0 S/D -1 S 3 <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CR[DIT CARDS ARE NOT ACCEPTED <br />_J�I(O F�ifn_1Cpr �-�%� <br />PROJECT ADDRESS <br />"�vc Ph <br />Owner <br />7enanl <br />` o . Po 3a,�3 < <br />h1a11 Address <br />Ma�l Address <br />Ls �Tc,c P o 3 <br />ElectricalContractor 61a�i.�ddres, <br />ShO�owLCS IlOp4! <br />State License N�mber <br />/�P A.cT •�-`e,,.T c <br />Proposed Use of Bwlding <br />�y C <br />City <br />City <br />�c Z 7 S <br />ciry <br />Oescription of Work to Be Done: w i C' � �'{ 1� L�.� <br />NOTE: WIRING iN NON-nWELUNGS IS RE�UIRED TO <br />BE IN RACEWAYS. MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />State2ip <br />State2ip <br />S�tn�w <br />4Z5 -33q <br />ssoZ <br />P"ane <br />Phone <br />tiZs-3S; <br />98Z5i <br />State/Zip P�one <br />� 8 Z. S % , ""_— <br />Contr ct Pncc of Work <br />Contact Person (Plan Review) <br />l hereby cer7dy thaf I have read and exanvned this apolicatren and know fhe same to be true and <br />ccrrect. Al! prov�siens al laws and ordinances gavr.mmg this type u(werk wdl be cempleted <br />�+hefher speciFed herem or not. ihe y�antiny u/ a pernir7 Joes not presume tu give aufhority fo <br />violate or cancel the prev�s�ons ol any ofher state or local la�v regulafing construction or the <br />pertcrmance o� censtruction. That 1 am aufhonred by !he owner o( this property to peAorm ihe <br />wcrh 'or �vhich applicatien is made and I compty with !he Sfate Centractors Caw 78.27 RCW and <br />296.200 bl'AC� � <br />� I <br />y �� <br />- � � <br />FEE <br />3�3,�� <br />