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ELECTRIGi4L PERMIT AP�LICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8610 - FAX 425-257-8857 - www.everettwa.org <br />�v� <br />PROJECT ADDRESS <br />mc������ <br />Owner <br />Tenant <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />� �5� �+�� <br />Mail Address <br />Mail Address <br />Ci�y <br />Ci�y <br />w � i��,���j <br />State/Zip <br />Stale2ip <br />Phane <br />Phone <br />�i �"". �01-� 7 r�,J 7�CzC' i G Z.1�C <br />Elec�rical Coniractor Mail Au9ress . Cily State2ip Phone <br />�.'� �ZI L �� �- �`� �1 L L.. <br />S�ate License Number <br />�, <br />� -tij �� � � o�L��-- <br />Proposed Use of Buitding <br />� �� <br />Contrect Price of Work <br />���"L�o_ 1 "C 1`� 1 ',f1C.�lJ�2 <br />Contact Person (Plan Review) <br />ti���1Llc�'cl—a--� 1Z� <br />Descriplion of Work lo Be Done: '��Y\ 7)� ��� L'1� ��"�"Z17 �%`� j c.1 v�`�-� >> <br />1 ��u-r-ls�' � ���+.-.L S T�cfm���,�^� <br />NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO <br />BE IN RACEWAYS, MC OR AC CABLE. <br />CITY OF EVERETf LOCAL SALES TAX CODE IS 3105 <br />FEE <br />I horeby certily thaf I hava read and ea�arnined (his applicafion an,i know the same fo be true and ��i 0 11 -(0� <br />correcG All provisions ollaws and o�dinances govemmg fhis type ol wo�k will be complefed <br />whefher specilied herein or nof. The granfing ol a pernuf does not resume to give aufhonly lo <br />violafe or r.ancel fhe provisions o/ any ofher sfate or local law �eguPfing consiru..fion or fhe <br />pedonnance ol construcLon. That I am authorized by fhe owner ol this property lo pedorm fhe <br />work lor �vhich application is made and 1 compty wdh the State Contractors Law 78 27 RCW and <br />295.200 WAC. <br />, <br />�� �_O�-��— � 1� 'J��� % �� <br />