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OJi2B%200i Oi:aO F.�iS <br />ELECTRICAL PERMIT APPLIC�ITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETf, WA 98201 <br />425-257•88'10 - FAX 425•257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />.�� ��_v,r��-� <br />PROJECT ADDRESS <br />Owner <br />Tenant <br />Elec�rical Conitactor <br />M..: AOdmss <br />MailAddress <br />Mall Adtlrecs <br />�il P,c� 5 ee�` I 4/!� 'f� � <br />Sf3le License Number <br />�e 5! Ck�e Jl C P <br />Proposed Uso ot Building <br />Descnplion of Work to ee Done: <br />NOTE: WIRING IN NON-DW[LLINGS �S REQUIRED TO <br />BE IN RAC[WAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX cODE IS 3105 <br />cm <br />StatofZlp <br />StaWZip <br />Slata2lp <br />�ooi <br />3 -�8-�7 <br />C-d�o3-�y� <br />� � 5D � <br />Contract Price o( Work <br />Contad Pereon (Plan Reviow) <br />FEE <br />1 herebv certi/y that I hB�e rend end examined tl�s applicAUon and know fhe sBmN fo be 7Ne and � V-� �"3_ `�� <br />tronact. A71 pruwsions of la�rs and ortlinancesgoveminp thiS rype o�wo�k wiil be comp/eted <br />whelher spec�fied horain or not. The granting of e perma does not presume fo gn�e outhady to <br />�iolate o� c�nce/ tne provisionsol ony ofher dfate or 1oc91law re�7u/ating conshucGon or the <br />pedo�mance o/ CUnsWctiOn. Thaf ! am auth0li:od by fhe ownnr oEbls property ro porlorm the <br />evrk �or which apyhcafion is made snd I complywifh the Stete Confractvrs Law 18.27 RCN� and <br />296.200 W'A%C, �� <br />/ / �C /n I t:1 � � / .� ... / .. .., <br />Phone <br />Phona <br />Phona <br />