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ELECTRI�AL PERMIT APPLfCA►TION <br />ClTY OF EVERETT PEP.MIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8Z57 — ww�,v.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />ii,- ./ Cin . <br />L� �� o�� ��� �I/ l_✓L%C �1 �,✓/f I(: (. (, L� <br />PROJECT ADDRESS <br />'i�' /_ <br />,>� %�; <br />Owner <br />Tenanl <br />Mail Address <br />Mail Address <br />City <br />Ciiy <br />WiF <br />State.�Zip <br />State/Zip <br />Phone <br />Phone <br />✓I i�% <br />Eleclrical Contraclor �fail AdAress Ciry State/Zip Phone <br />j!i �� : �,��� <br />State License Number Contract Price ot Work <br />�1 , �Hc�u,,, � �� <br />f o����il'� � <br />�7 �l2S "�c�i-�5c%� <br />,�PS��Crr, ��r�q/ <br />Proposed Use of Building Contacl Person (Plan Review) <br />[ � <br />DBSCfI�lI0f10fWOfkIOBCDOf1B: e%4Cg ��+��� /v�'_�v-i:.i�� G�/7 OC�/���f5 °�5 'G✓GJC'C{"i��'� �� %�/�-�(� <br />(,��i.rl� I^ �ivv(- G�.Yrr�)Lr�9 DL�/.iii, �; n /1D✓ir. �'>�"r.�� / (7F_ UC//�Y-%7 Oir!% /Ef.�/r <br />FT � / <br />.� Cro %/r f� _i /' jvi'' / i7r`,/ c-t'. �» 9-n.! <br />NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO <br />BE 1N RACEWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I he�eby cariily lhat I liave �end and exantined this applice!ion and kno�v Um same to be true and <br />correcL All piovisions o/lan�s �nd ordinances governmg fhis type ol �vork �vill be completed <br />�vhefher specdied herein or noL The granfing ol a pennd does nof presume to give aufhonty fo <br />violate or cance/ the provisions o/any other state or loczl law regulafing construction or fhe <br />performance o/ construc6on. Tliat I am aufhorized 6y Ihe owner o/ this properiy fo perfoim the <br />�vork (or which application is made and 1 comply wifh fhe State Contracfors La�v 78.27 RCW and <br />296.200 WAC. <br />/ , / C � <br />/ _� /,/% �C.7 <br />_ - ✓:=�- � � <br />� Signature Dale <br />FEE <br />�- �'7!� `I-� ��l I <br />z <br />� <br />