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ELECiRICAL i'ERMriT APPLICATION <br />CITY OF E4�ERETT f�►c'RMIT SERVIGES <br />3200 CEDAR STREET, FVERETT, VVA 982Q1 <br />425-257-8810 - FAX 425-257-8857 — wv�,v.everettwa.oro <br />APPLICATIONS ARE ACCFPTED FROM 8 AM TO 4 PM <br />i <br />_ ��.' �n r'�t i)2 C� <br />PROJECT ADDRESS <br />�C �'c�itil��,c t�r � <br />owner <br />Tenanl <br />� � <br />_d� �_c' 7�'�Fi_ �t'Si;i:_ ;S.Z.S �J/�;:� <br />A1ail Address <br />��1ail Addruss <br />City <br />Cily <br />t t't '-� f � � ' �i <br />� r� Lu,4 9t_ <br />S, �elZip <br />State/Zip <br />Phore <br />Phone <br />i'��tr�N'lc� F:�r�,�,2i(� z/U,S' Si�'f2 L 1r Sk�,> L-; a !,�',z5-b' �11s' 3"S5" 7���u <br />Eleclrical ConUaclor M1tail Address City State/Zip Phone <br />V�t��� �� � �= i�i �� rn �� <br />State License Number <br />'_; r� r <br />� <br />Froposed Use ot Building <br />Description of Work to Be Done: � �-`�_ ) _ �-. � -% -J � �—/Z <br />„` <br />NOTE: WIRING IN NON-DWELLINGS IS REQU!RED TO <br />BE IN RACEWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />�Y� ' �`' <br />� `ic�" 3;� , <br />Contracl Price of Work <br />Conlact Person jPlan Review) <br />I hereby ceriil� fhat 1 have read and exarnined this application and know fhe same to be true and <br />correct. All provisions o�la�vs and ordinances governmg fhis fype ol �vork will be complefed <br />whether specilmd herein or nnL The granfing of a permd does not presume to give authority fo <br />violafe or cancel fhe provisions ol any other stale orlocallaw ie�ulating construction or the <br />wo�k lorawh ch applicri�on�'s ade acd�l co�nip ye�th fhe State ConfractorsnLa v 18 27�RC61�'and <br />296.200 WAC. <br />/ � <br />! � ^ <br />i �� ) <br />� L G�C /' <br />�'� ���.. /— `7'C'i <br />---T— <br />FEE <br />� <br />