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ELEGTRICAL PERMIT APPLICATION <br />CITY OF EVERETT P�RMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM S AM TO 4 PM <br />�(., �3y�' St <br />PROJECT ADDRESS <br />% / (� - 3 `J ��' S �— <br />, <br />� � �, <br />O�e� Mail A� dress <br />Tenant <br />Nail Address <br />y9/ 7 t`, <br />r f.'✓ e rP Iy <br />Conlraclor Mail Address <br />' � ]C L_ <br />late License Num�er <br />5�� <br />Proposed Use of Building <br />Descriptiou of Work lo Bo Done: <br />i � <br />�y� f ����� ,,.���«clr . — <br />NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO <br />BE IN RACEWAYS, MC ORAC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br />Cily <br />Stale2ip <br />a �''a.C� "�Z <br />Ly'/uJZ -i`J�5 <br />Cily State2ip <br />����� w��y�y�o - <br />. n � r-, �> n 'T ��T 7 <br />Cily <br />2� y-�y <br />Phone <br />Phone <br />�5�L2 —Z9 SC <br />Slale!Zip Phone <br />OU <br />U Q �� <br />Contract Price of Work <br />Contact Person (Plan Review) <br />1 hereby cerlily that I have read and exarnined Uiis application and kno�v the sarna to be true and <br />correcL All provisions o(la�vs and ordinances goveming this type o/rvork will be comp/eted <br />whefher speci/ied herein or noL The granting o(a pernut does rot presume fo r�ive authonty to <br />violate or cancel the provisions olany other state orlocalla�v regulafing r.onsfrucfron or the <br />perlorrnance ol conshuction. That 1 am authonzed by the o�vner of this propehy to pedorm the <br />�r•ork for which ap(�lication is rnada and I comply wilh fhe State Contractors La�v 18.27 RCW and <br />276.200 WAC. <br />FEE <br />CU <br />-rs -_ <br />!� 2 �j 2� /Z <br />� IZ�Z- I���S <br />