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; it 7 <br />PROJECT ADDRESS <br />ELtCTRICAL PERMIT APPLICATIO�! <br />CITY O� EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />4�5-257-8810 - FAX 425-257-8857 — www.evereltwa.org <br />g-o6--a> <br />APPLICATIONS ARE ACCE?TED FROM 8 AM TO 4 PM <br />; s ,-'� S_ <br />j �� ('�rT���r'�s <br />Ownef A1ail Address <br />Tenant ldail Address <br />i� <br />_.j�. �. � �= � C% S � �� L �� G-f �' i c <br />ElecliicalContracicr AfailAddress <br />-� <br />.i)L 1}�.'i�. 1 ���U (�L <br />Stale License Number <br />L� �,� !10 <br />Proposed Use o( Building <br />� ,9 ,: �, � <br />Cin <br />Ci�Y <br />(NG <br />City <br />Descriplion o( Work lo Be Done: ����i ��� � '� LL �n1 �� <br />NOTE: WIRING ItJ NON-DWELLINGS IS REQUIRED TO <br />8E IN RACEWAYS, MC OR AC CABLE. <br />State!Zip <br />Stale/Zip <br />C—O� a g <br />Phone <br />Phane <br />�i,�.v ��o�d (,�//r �<� u � 7 <br />StalelZip Phone <br />Conlract Price ef Work <br />Contact Person (Plan Review) <br />C ct /J�i J <br />CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 <br />I heieby certi(y fha! I have read and examined Ihis application and kno�t� the sarr�e to be tn�e and <br />correcf. All provisions ollaws and ordinances governmg Ihis type ol �vork ivill be completed <br />whether specilied heiein or noL Tiie granfing o! a perrnd does nof resmne fo give authonty to <br />violale or cancel the provisions ol any other sfate or local law re�uPting construcfion or the <br />performance o/consVucbon. That 1 am authorized by the o�tiaier of this property fc peAonn fhe <br />�vork for which application is made and I cornply �vifh Ihe State Contracfors Law 18.27 RCW and <br />296.2001NAC. ,, <br />�� <br />�Ii �� <br />T' � r <br />Jrf �._ � Ul' �� <br />� <br />� � � <br />-> �: <br />FEE <br />n <br />/ � . �� <br />�;1 � � <br />i�� c <br />