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ELECTRICAL PERMIT APPLICATION <br />CiTY OF EVERETT PERMIT SERVICES a$�pb <br />3200 CEDAR STREET, EVERETf, WA 98201 (8 " <br />425-257-8810 - FAX425-257-8857—www.everettwa.org �p6/a—/6� <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />_ � �� ��ti'�f��i�`� � ��� <br />PROJECT ADDRESS <br />�� <br />l���,l�: ��� <br />Owncr <br />GitiV lQu � <br />Tonant <br />Eleclrical Conlrador <br />State License tJumber <br />Proposed Use o( 6uilding <br />Description ol Work l0 6e Done: <br />,� <br />7a,� ��t���1 ��I� <br />��5�;,� �Li'��r <br />Mail Address <br />Mail Address <br />1.7a11 �ddress <br />j�? V V� C.C�- � Ci� <br />City <br />Cily <br />Ciry <br />�_ <br />?-�-t �,� c,�f1 �s_��-� <br />Slale/Zip <br />Slate/Zip <br />State2ip <br />ConUacl Price ol Work <br />Coalacl Person (Plan Review) <br />J O�C/ i}' <br />��d�n�iLtiw �( ��17 u�� i,��-,%G:' <br />NOTE: WIRIIJG IN NON-DW[LLINGS IS REQUIRED TO <br />BE IN RACEWAYS, A4C OR AC CAE3LE. <br />CITY OF EVERETT LOG�L SALES TAX CODE IS 3105 <br />1 hereby ce:�tily fhaf 1 have reaAand eA�amined this application and know fhe same lo be Vue and <br />corrocL All provisions ol laws and ordinances yoveming O�is type o( �rork n�ill Le compleled <br />whefher specilicd he�ein or noL The yran(ing ol a pemuf does not uasume fo give aufhonty fo <br />violate or cancel the Inovisions ol any ofher sfafe or local law regulafing c�ns(ruction or the <br />perfom�ance o/ conslnicfion. 7hat 1 am autAorized by the o�mer o! this prapeity to pedonn tlie <br />�rodr lor ivhich applicntion is,made anU I comply �rifh tlie Stale C'ontracfors Law 78,27 RCW and <br />29G.200 WAC. / <br />' /� � % <br />1 ' v"„L'�� � I/� f t-L �� � ��/� ��� � �� �i�:-�� <br />FEE <br />' l�; �J�s 9 <br />Phone <br />Phone <br />Phore <br />_C.��r f <br />