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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERIUIIT SERVICES <br /> 3200 CEDAR STREET, EVERErf, WA 9a201 <br /> 425-257-8810 - FAX 425-257-8857 -•www.everettwa.org � ` 5� �Z <br /> APPLICATIONS ARE AGCEPTED FROM 8 AM TO 4 PM (�/246�� � <br /> �0/l 12f� 0�f-� .�ie��Gf C�r.�.�� r.�la1 Sg <br /> PROJECT A�DRESS <br /> I���,� 12����1�c,�n � �su����11r�, I�� �'�'��� <br /> Owner MailAddress City State/Zip Phone <br /> V� 1 Gv m� ���m <br /> �' State2i Pnone <br /> Tenant Mail Address Ctq' <br /> Pr�e��is��► ����i�, ��� ���.�t� s��um����, �� ��U2z <br /> �lectrical Contrac�or Mail�ddress City SWteIDp Phone <br /> c � <br /> p.Y�C�e� �gy�� � �� <br /> State License Number Contrac Price of Work <br /> � Vl ,� Ml " � I �JI G��I� _ 2��i �'I <br /> Propose 1 Use of Buildii C n cl Person (Plan Review) <br /> 2220 <br /> Squa�e Footar�e(If residential new conatruction, �emodel o�addition) <br /> Qescription of Work to Be Done: <br />� <br /> 20� �mp Vn�f�rrn� t�ew��wql� r�il+�2�sld�n�i <br /> NOTE: WIRING IN NON-D�NELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AG CABLE, <br /> CITY OF EVERETT LOCAL SALES 7A7C CO�E IS 3105 <br /> f herp6y ce�2ify that I have road ond exnminad this application and know Nie esme to 6e fruc and � -�! �'_ � <br /> conect. All provisions ol fa�vs and oidinences goveming lhis type of wak wll!be completed � I� ��l>- <br /> vihethar specifiad herein or noC The granting ol a pem�d does notp resume fo give aulhority to <br /> violate or conCel the provision°of any other stnte orlocol faw regu/aGng construclion or the <br /> porfnrmance o/consirucfion. That 1 am authonzed by the ownero(thisp mperfy fo pedorm the <br /> �srork for which applicetion is made and 1 comply wifh tho State Controcto�s Low 18.27 RCW and <br /> 296 0 WAC. <br /> U �12 <br /> Slgnature Date <br />