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1 <br />ELECTRIC.AL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />32U0 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />��l � d �19�'�� s fi� c.--� �Uz,-��n , ����, <br />PROJECT ADDRESS <br />�.�_���x�l� S«�•�-+ ���...:5 r�c�: s.�(�. <br />Owne Mail Address <br />Tenant Mail Address <br />l—l},,�.�.,�� 5 �•; �.<<1�.� ����i A,� D� <br />Electricat Coniractor ldail Address City <br />l-%liz(��-F'E� �rz � �'-k <br />Slate License Number <br />Proposed Use vf Building <br />i� 1 ` <br />Description o( Work to �e Done: %' �.�-J (�� u:> / lLcct- � <br />NOTE: WIRING IN NON-DWE! LINGS IS REQUIRED TO <br />BE IN RACEWAYS, MC OR AC CABLE. <br />C�TY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby certi(y fhat 1 have read and exarnined fhis ap�lic <br />carecL All provisions ollaws and orAinances govemmg <br />whefher spec�fied herein or noL The �ranting o( a pernuf <br />violafe or cancel the provisions ol any other state or /ocal <br />performance of conslruction. That I am authonzed by fhe <br />work (or �vhich application is made and 1 comply with the <br />296.200 WAC. <br />and know the <br />✓pe oI work w <br />nof presume <br />� 2 ��, <br />Slate/Zip <br />Slate/Zip <br />�� <br />�� 7 <br />Slale2ip <br />Contract Price of Work <br />z�.;-caz� <br />Phone <br />Phone <br />%(rE =�-9e?6 <br />Phone <br />Conlact Person (Plan Review) <br />s fo 6e true and <br />completed <br />ie aufhonty to <br />tion or the <br />o pedorrn fhe <br />8.27 RC W and <br />FEE <br />.J <br />