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PROJECT ADDRESS <br />r,�,� ��� �, <br />Gwner <br />Tenanl <br />�/��v�o�ic , <br />Eleclrical Contractor <br />( <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 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 />C /5' `�' S/�° S <br />h4ail Address <br />Mail Address <br />'G'�i'Y E �. � 0+ / <br />A1ail Address <br />��{Gud�ZD �'g,%G <br />Slale L icense Number <br />� <br />�� s�of't� <br />Proposed Use of Buildinc� <br />,�-�� �G���� /z yi` � .YZS`. ,Z � 3'.. 6' �. Z ; <br />� :�'� �' . <br />City Slale/Zip Phone <br />Cily Stale2ip Phone <br />�3 `� /� fis/ l! C/%¢. `-3�'c%J"/- 0.2.i`� <br />Cily Statc'Zip Phone <br />`�r.5`O � .�`6Gc� <br />Conlr�cl Price of 4'Jork <br />f /G��wa�' <br />ao� - z Zp- � .�/ 7 <br />Conlact Person (Plan Review) <br />Description of Work l0 6e Donr.: � S��/� ✓����q � nfl'loc��r/^ .%/fLG'✓� ��o:c�Tia,(.G-�- <br />i <br />� �'�.�a /�. /•Ui �'t �-v <br />� <br />NOTE: WIRfNG IN NON-DWELLINGS IS REQUIRED TO <br />E3E IN RACEWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby certify fha( I have read and examined this application and know fhe sarne to be true and <br />correct All provisions ol laws and ordinances governing fhis type o/ work will be completed <br />whefher specilied herein or noL The granting ol a perrtut does nof �resume to give aufhonty to <br />violate or cancel the p�ovisions o/ an}� other state or local law reflulating consfrucfion or the <br />peHormance of construcGon. Thaf I am aufhonzad b}� fhe on�ner of fh�s property to peAonn the <br />�4ork Ior which applicstion is made and I cornply wifh Ihe Sfate Contractors Law 18.27 RCW and <br />296.200 WAC. <br />FEE <br />I� O�D�-r5'-� <br />