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ELECTRICAL PERMlT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 I�—/y —�Z <br />425-257-8610 - FAX425-257-8857—v,nvw.everettwa.org L��Z2_��7 <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />'I ��' �% �J F'1 .M I I / i �� r_ <br />PROJECTA�DRESS <br />�1 <br />(,J �I� ^� �') �1 � !�-r' (�" <br />Ov+ner <br />h7ail Address <br />City <br />Tenan� h9ail Address C�ty <br />� C� /'�?l��SaN �LC=CTI2�C lt^/c:._ 33ZZ <br />GledricalContractor MailAddress City <br />1)� �'�- � �uoc �C <br />State Licens� Number <br />SFr7 <br />Proposed Use of Building <br />2a�� <br />Square Foolage (If residenlial new consiruction, remodei or addilion) <br />Description of Work lo Be Done: � r w��^ r � ti T T(� 1`�� -� s r. <br />NOTE: WIRING IN NON-DW[LLINGS IS REQUIRED TO <br />E3E IN RACEWAYS, MC OR AC CA�LE. <br />State2ip <br />State2ip <br />13Z �<: s,- S � <br />Slate�Zip <br />Contract Price of Work <br />Phone <br />Phone <br />�Y,v,✓wo� <br />Phane <br />Contact Person (Plan RevievQ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby coriily (hat I havo read and examirr.d fhis npplication and kno�•� fhe s�rne fo be 6uo and <br />co�recl. All prowsions o//mvs and ordinances governing Ihis fypo ol �•rark v,ill Ge completed <br />�vhethcr speci�ed herein ornoL The g�anlm9 o!a pemnf does nofp resume la give authonty to <br />viola(e o�cancel the provisions o(any othersta(e orlocal lmv regulafing construction or the <br />peifornrance o/construc(ion. Ihot 1 am authodzed by fhe o�:nero/this property to pedorm the <br />work /or �vhich applicafion is made and I comply �vi(h the 5(afe Con(rac(ors Lmv 1827 RCW and <br />296.200 WAC. <br />� '�,y,_. : �'�r � �� t�:' � � �-� � Z <br />re <br />i= i i'� Ni=� G/9R.��E <br />FEE <br />"� `bC� o� <br />�.���,�-/)d, <br />C <br />