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ELECTRICAL Q�RNlIT AF'PLIC�►TION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.evereltwa.org <br />APPLICATIONS ARE ACCEPTED FROM S AM TO 4 PM <br />� 5 I S �� a-`� S-E. <br />PR T ADDRESS � g a('�� <br />�f�el"' <br />Owner <br />Tenant <br />Mail Atldresc <br />Mail Addmss <br />` ,�l.c� �T ` � �S �� <br />Electrical Contrector M� <br />ri�Y <br />Cily <br />� <br />� � � �� <br />r17.g'r r..{,,.�:rr�';da�'D�iiO <br />i: �� •r�l i. 'S'<� ! 93?03 <br />LP � � � �g -�'ti_ <br />State License N�mber \ � � <br />�l� � t C�9-v�.L4 ` �J �\% � �S � �1"1� �L <br />Proposed Use of Building <br />Deecription of Work to Be Done�. <br />� , lJ���J �-�.t <br />U �t�rVl_�< o _I <br />NCTE: WIRING IN NON-DWELL�IJGS IS �EQUIRED TO <br />BE IN RACEWAYS MC UR AC CABLE <br />j�'` � S <br />S�o1�2.p <br />StalelZip <br />S_o'?�`/z <br />C12a5-l3, <br />, / ��U'CS� <br />?hone <br />Phone <br />StatelZip Phone <br />�✓ Vl� <br />Contract Price of Work <br />5-�- �..« l j <br />Contact Pers^u (Pian Review) <br />CITY OF FVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby r ehily that 1 have read and examined this applicalior and kno�v Ihe same lo Ge true and <br />correct. 411 provisions o( laws and ordinances c�ovemrny fhis type o� wodc will be complefec/ <br />�vhether spe„ilied herein or not The granbnp o/ a pemut does nof presume fo g�ve airthordy lo <br />violale or cancel the pr�visions ol any ofher slafe or local la�v regulafing cronsVucfion or fhe <br />perlormanc�: o/consfrucfion. That 1 am authorized by the o�vner o/ fhis property to partorm the <br />v;ork lor which applicafion is made and 1 comply wifh fhe State Contracfors Law 1b.27 RCW and <br />296.200 W�. , <br />FEE <br />h <br />Ci2�S� - )3� <br />