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��, � Z�� <br />PROJECT ADDRESS <br />�qkc:.L.Jw D <br />O�vner <br />Tenant <br />[lectrical Contraclor <br />Stale License Number <br />ELECTRICAL PERMIT APPLICAT�ON <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 G`f� `G7 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org � <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ��>OS '�� <br />�'6"�����,� (��2 - <br />� ' � `C � �—'1 �-- <br />Mail Address <br />h1;�il �ddress <br />�fail Address <br />.c �` <br />Ciry <br />City <br />Gty <br />Proposed Use of �uilding <br />� <br />Description of Work l0 6c Donc: ��l�l�l� W"L-12. <br />NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO <br />DE IN RACEWAYS, MC OR AC CAE3LE. <br />�`l (� t-k :S�ct/CNS �11�Z� <br />StatelZip Phone <br />s�acerzip <br />Slale'Zip <br />�/zs 35� � �G�7 <br />Phone <br />Contract Pricc ol Work <br />:S[��L� �l%/�{/'y6'�S <br />Conlacl Person (Plan Review) <br />FEE <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br />I he�eby certd}- fhaf I have reod and examined this applicafion and knon the same to be true and <br />correcL All pro��isions o! 12ws and o�dinances governing Ihis type ol a�ork �vill be cornplefed [ (; 4� <br />rvhefher spe.citied herein o�-not. The granfing e/a pennd does nol �resume !o give aulhority to C � � �` 3 <br />��iolate or cancN fhe pravisions o/any ofher sfate orlocalla�v rec�u��fing construction o� the <br />pciforrnance ol conslrucfien. ihat 1 arn authonzed b}� Ihe owner ol Ihis property to perfomi fhe <br />u�ork lor �vhich application is made anAl cornpl}� �rith (he Sfafe Contractors La�v 18.27 RCW and <br />296.200 WAC. <br />_._.. _ _ 1 <br />_--.- -L.- �: � %��� <br />Phonc <br />