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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STP.EET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEP i ED FROM 8 AM TO 4 PM <br /> I l� I �t 1�-�� � v�= S � J� � \ <br /> PROJECT ADDRESS <br /> c�as� �- s�� �.o� <br /> Ownef MailAddress City Stale/Zip /Z�� Phone <br /> OLc� Ni �i� C��l- c �C �_ r � �z-rj0 _ 7o�Q <br /> y �_� 1 � ��0 � � ��j� �n � UL S� i � UZPe }{-�,�y� � <br /> Tenant Mail Address City State/Zi <br /> P Phone <br /> .JQ �^f-4 � lPL�-J'�L GZ6�j / ��Z.�c/ / Sc, �C'�l p �253� g�3-�i� <br /> � ��I �1A � ^ �L r � � ln.){� 1��.3� 3 <br /> Elecirical Coniraclur Mail Address City StatelZip Phcne <br /> Mb� iV�.�C� �S ��q � 3�Q�, o� <br /> Stale License Number Cuntract Price o(Work <br /> �c �(�`'� S�� � NR,� L SnCoo .�1 .�er,nz�Ci.� <br /> Propnsed Use o(Building Contact Person (Plan Review) <br /> Description o(Work lo Be Done: �2 n n�✓1� .� 1'v���"o�'Pvv�,�-}— � .A�_ ��vl�j /�D�' Q <br /> �U _� e �s �_nc � al � �� �, rlec -1 fi'cnL %o� l,�lQ �-er �en1e�� �'�lF � <br /> I,JAS���� J_ I�la (' �,. ' �� ,�1� C'fJi1nec�t -�o � XiC �h ' n� �o1V1P ct ����Su� Jqn. <br /> :- r� <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODF IS 3105 <br /> I here6y cedily Ihaf 1 have read ar,d examined this application and know the same to be true and <br /> correcL All provisions o/laws and'ordinances govemmc�this type olwork will be completed <br /> whether spealied herein or not The granting o/a permd does nof presume to give authoriry to <br /> violate or cance/the provision o!any other slafe or local law regulatin�construcfion or the <br /> peAormance o(construcfion. h t I am authoiized by fhe owner oJ th�s property to peAorm the <br /> work lor which application is na e and I compty with fhe Stafe Contractors Law 18.27 RCW and <br /> 296.200 WAC� , <br /> _�-----� <br /> � _.. �' -� .___. —. .. . . <br /> .���__ .s= . <br /> , <br /> ��--�-� �' �Z � � • 2 vv s <br /> S�gnature �� Date <br /> L�— <br /> ��`�/ � 'S 3 I <br />