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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT P�RMIT SERVICES <br />3200 CEDAR STREET, EVERETT, W,4 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FFOM 8 AM TO 4 PM <br />� . <br />1--. � � 2 ��-��-� �?�', <br />PROJECT ADDRESS <br />'.�l(�� 1Lc�V/ il � 7?C�� `! �1� <br />Owner � M1fail Address Qry <br />Tenanl Mail Address <br />i <br />� �'( :.�✓�1.ti�� � �LC� 1 r_ 4 �1�1C , <br />Electricaf Conlraclor Mail Address <br />�'� � �; ���� - i - `� -/ �i � <br />State License Number <br />Proposed Use o( Ouilding <br />DescriptionofWorkloBeDone: �:''�� �1.�`"�-'�-�-- <br />�i`l �� �� <br />_ `' � <br />NOTE: WIRING I�I NOIJ-UV1'ELLINGS IS REQUIRED TO <br />BE IN RACFWAYS, A1C OR AC CABLE. <br />City <br />��L�„_ �., � // <br />Slate2ip <br />S;a�e/Zip <br />s��� ��� ��� �,��i��..,, l�/.l- v� 7U <br />CiN State2ip <br />-� r, �._ <br />'� �=-, - - <br />Co;�tract Price of Work <br />Conlxt Person (Plan Review) <br />� ��C��\S' � �.� (��. <br />CITY OF EVERETT LOCAL SALES TN( CODE IS 3105 <br />1 hereby ce�ii�y Ihat 1 have read and examined lhis npplicafion and kno�v fhe sarne fo be true and <br />conecL All p,ovisions o/laws and ordinances �overning this fype ol u-ork will be cornp/efed <br />whether specdied herein or noL The granting oI a pernut does not resurne fo 9ive aufhonty to <br />violale or cancel fhe provisions olany olher slate orlocal la�v reguPfing conshuc6on or fhe <br />periormm�ce o,` conslrucfion. Thaf ! am authonzed by the owner ol this property to perform the <br />work la- rohich application is rnaAe and I comply wifh the Sfale Contractors Law 18.27 RCW and <br />29G.200 WAC. <br />I '-� r—� <br />_ '� „��� / �— ��'�/' / <br />` Signatme�-". . _ �i- Oate - . <br />FEE <br />Phone <br />Phone <br />� %�, . <br />Phone <br />E��l? —IG3 <br />