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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVEG2ETT PERMIT SER!/ICES <br />3200 CEDAR STREET, EVERETi', WA 981.01 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />j� C� 1 �c���' S"�� . <br />PROJECT ADDRESS <br />��.,�� l <br />Owner <br />Tenant <br />e;,�l,�y�,� <br />Mail Address <br />Mail Address <br />,x'I �!Ec J' / u 5, J a'!,�'lv( <br />Eleclrical Conlraclor Mail Address <br />�ir�l ��/ <br />State/Zip <br />Stale/Zip <br />�'�)��� C �iJt_ iy;'%�I y Y-�! <br />City <br />``�i.�/i��:,�f-��i�� ' /�%��;?7s�'r�/('�l/ <br />Slate License Number <br />Proposed Use of Buildinc� � <br />Desr,ription of Work to Dc Dona ��1 �. -fi (" <br />( /I����'�� :,%c'�� l.. �' P_ <br />l--� <br />NOTE: WIRING IN NON-DWELLINGS IS REQUIRED l0 <br />BE IN RACEWAYS, MC OR AC CABLE. <br />,: <br />State2ip <br />c /;7> <br />�/b J�d = <br />Phone <br />Phone <br />7,.-7J .r'.�� ..�� <br />Phone <br />J�oc,. �� <br />, <br />Contract Price of Work <br />Conlact Person (Plan Review) <br />CCtI �J S� C�c���c C' cJpc..i.. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1(iereby certily that I liave read nnd exnmined Ihis application end kno�v Ihe same to be frue and <br />corrr.ct. All provisions o(laros and o�dinances governinc� this type oI u•ork will be completed <br />�vhether speci(ied herein or noL The granfin� o/a pernuf does not nesume fo give authority to <br />viola(e or cancel the provisions ol any other sfate or local laiv regulsting consVuctron or fhe <br />per(onnanr,e ol construction. That 1 am authorized by Ihe o�vner o/ this propert}� to pe�form Ifra <br />�vork (a �r4:ch applicafion is made and 1 wmpiy with (he •State Lbnfractors La�v 18.27 RCW and <br />296200 l4'AC. <br />� i � <br />. <br />/�! � c . . �-1_ � - / C� - l, <br />FEE <br />� l I � 5- U=-r z <br />