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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES 5_� ,_0� <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8657-www.everettwa.org C� 07�j.__/ 3 3 <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> /�%/U �t'r,,�/' /�i� l'L��'�' �� <br /> PROJECT ADDRESS <br /> Ti ��,� ii � . ,:' �• ..�� �%l! l''.ri:t` ' l�if. 4at �1%e.�Gy/ <br /> Owne� A1ail Address Cily Stale2ip Phone <br /> Tenanl Mail Addross Ciry State2ip Phonc <br /> / i � /J <br /> l! �{'�.���n/'� �/Af'l'(' ��L/ 'c l7h' �/I u� /�[j �7�/�Ns�/,-_Y'i l��- �lY: Gz y. S'i j f <br /> EleClrical Conlratlor Mail Address Cily State/Zip Phone <br /> ' 1'�✓�'9 <br /> �f�'��- L , r <br /> , l %�/nl <br /> Slale License Number CoMracl Price of Work, <br /> Proposed Use ot Building Conlact Person (Plan Review) <br /> �/ � � <br /> - �...._ �- ' 7%n/Y-'%' � f�-'���� /J ,. / <br /> Doscriplion of Work to�a Donr_: i i' "� / /'' � <br /> NOTE: WIRING IN NON-DW[LLINGS IS REQUIRED TO FEE <br /> �E IN RACEWAYS, MC OR AC CACiL[. <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> 1 hereby ceitily fhal I have read nnd e:arn�r�ed fhis applicnliun and know fhe sarne to be We and <br /> correcL All provisions of laws and ordinances govenung this lypo ol�rork�rill be cornplefed <br /> rrhether specified herein or not. The granting o(a pemuf does not/irestano fo gire aufhority fo <br /> violafe or c�ncel the �rovisions ol mp�ofher s(ate or local law ragu ating consfruction orlhe <br /> perfomiance ol cons�niction. 7'hot 1 am euthonzed by the o�sner o(this properly fo perlomi the <br /> work!or�rhich application is made and 1 comply�vith fhe Stafe Centractors Law 1827 RCIM1�and <br /> 29G.20q 11�AC. <br /> , : / � I , `� <br /> _ � �;� ;;, . 7 �;� <br /> Signalure Date <br />