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ELECTRICAL PERMIT Ai�PLiCATION <br />CITY O�' EVERETT PERMIT S�RVICES <br />3200 CEDAR STREET, EVEHETT, WA 9A201 <br />425-257-8810 - FAX 425-257-H857 — wvuw.everetiwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />,�jG' � ti���.�.-� ;{� :��� <br />PROJECT ADDRESS <br />Tenant <br />� <br />� iU•^['� <br />Electrical Contractor <br />State License Number <br />� � i1 <br />Proposed Use of Building <br />Descriplion of Work to Be Done: <br />L�C <br />Mail Address <br />Mail 4ddress <br />Mail Address <br />� <br />NOTE: WIRIfvG IN NON-DWELLINGS IS REQUIRED TO <br />BE IN RACEWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX COUE IS 3105 <br />1 hAreby certily that 1 have read and examined this applic <br />correci All provisions ollaws and ordinances govemmg <br />whetherspeci�ed herein ornoL The granting o(a permd <br />violateorcancelthe �rovisionsofanyofherstateorlocal <br />wo�k lor wh/ ch ac� licatio !s ma'de and 1 co�m� IZ w th fheE <br />296.200 WAC. p� p y <br />� � <br />ill;// i��crk <br />ciry <br />City <br />Cfly <br />Stale2ip <br />State2ip <br />Slate/Zip <br />Contract Price of Work <br />Contacl Person (Plan Review) <br />and know the same tn be true ano <br />ype o/ work will be cornpleted <br />r nof presume to give authonty to <br />a�d <br />FEE <br />�� _ •._ <br />i <br />� � �c � 9/i5" � �- %� <br />�_ , / / K'i �'v^_ �I C'J <br />nature � � tlata �— <br />Phone <br />Phone <br />Phone <br />