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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERiVIIT SERVICES <br />3200 CEDAR STREET, EVERE-i-T, WA 98201 <br />4?_5-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FR0�1 8 AM TO 4 PM <br />1 zv � 3 z i S� A v;= s F F�t,� t.� ivA 9�zv� <br />PROJECT ADDRESS <br />�/ <br />Vf 1 <br />Owner <br />Tenant <br />Eleclrical Conlraclor <br />State License Plumber <br />Proposed Use o( Buildinc7 <br />?`lZ3 2/ %r <br />Mail Address <br />Description d JVork lo [3e Done: <br />Mail Address <br />Mail Address <br />City <br />Cily <br />City <br />� �-I a � �/ <br />�I109-O�I� <br />1ti/! 9 �1�� yz� ' <br />State2ip <br />Stale/Zip <br />Slale/Zip <br />Contract Pnce of Work <br />Conlact Person (Plan Reviee�) <br />»'1-GY/, <br />Phone <br />Phone <br />Phone <br />/� ryJ v / � <br />/.�"ii��,�� i'=ce��,� ;�,a�l_� �[�"y_��oS�7 iTi L�,?/�[�rT '�lte n(�f C�-rlc rc_-ticv� {�� '��e <br />C��c�� Il l G��c' �G V �1'1'1 Iti -1�( �`' /'V14 �Tti' C/C \c'� �'i �/� '�hC��- C�.•,.�� �c <br />)�:i���� 'L %'I�1�Vi:n� JreY�'.:'i�vt� �iT� SG✓ht �-�f'C'l /ICttl C/�..T�C�S �O Sl��%Li� /�`tl /�CLf <br />� V {"�'j-� �j �" �:�� lol�l . <br />NOTE: WIRING IN tJON-DWELLINGS IS REQUIRED TO <br />BE IN RACEWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereGy ce�fily that I have read and examined this application and know the same to be truo and <br />correcL All provisions �� laws and orJinances goveminc� this rype ol werk will be completed <br />whether speci(ied herein or noL The granfing ola pernuf does not presume fo give authonty to <br />violate or cancel the /.�roe'sions of any ofher slate or local law regulaling consfrucfion or Ihe <br />performance o/ consfniruon. Thaf / am authorized by the owner o( this property to pedonn the <br />wo�k lor �vhich app.��! on is nmde and 1 cornply �rilh fhe Sfate Contracfors Law f827 RCW and <br />296.200 WAC. <br />� �7 <br />� � i�� <br />J�:1� c..-�_. <br />lZ <br />FEE <br />