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ELECI'RICAL PERMIT APPLICATION <br />CIiY OF EVERETT PERMlT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org �( � a 3 7 <br />i � �i, iC �� <br />PROJECT ADDRESS <br />1��,;� , 14 <br />Owner <br />Tenanl <br />��l�%�l �;.. �: K �: �.� ,_ 7ti' � c. <br />[leclrical Contractor <br />�/+7i�i l�� �� � 7 <br />State License Number <br />-o <br />APPLiCATIONS ARE ACCEPTED FROM 8 AM TC 4 PM �= 0]D �/-l6,% <br />Mail Address <br />fdail Address <br />���lZy �%v� L7 n <br />Mail Address <br />.� Il�� <br />,_'iNi �i_ -%-lV�ii I � '� ����._�t.L� ���4 <br />Proposed Use of Buildin� <br />Description of Work l0 6e Dune: <br />/� _i. br <br />� �� <br />NOTE: WIRING IN NON-DW[LLINGS IS REQUIRED TO <br />k3E IN RACEWAYS, MC OR AC CABLE. <br />lV <br />(• ,. , <br />Cily <br />Cily <br />Nc <br />�fl <br />SlalelZip <br />Slate/Zip <br />4z: '�v c� 7� <br />Phone <br />Pl�one <br />`l2; : %/ ��i--'1 <br />Cily Stale2ip Phone <br />,( � C�`-. ., <br />Conlract Price of Work <br />1/Yl�.'N ��iiiii"vi � �, <br />Conlacl Person (Pla� Reviev; ) <br />cr- ( !i� �•.c�ri��L t . ��i� <br />C. %�' � C <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby certily tHat 1 have read and exarnined this npplica(ior and b:no�r the same tv 6e frue and <br />correcL All prov�siens of laws and ord�nances governmc� this type of �rork uil! be cmnpleted <br />whetherspeci6ed herein ornoL The granfing o/a pernut does not presume fo give aidhonty to <br />violate or cancel the provisions o/an}� niher state or local la�v re�ulating consfructwn or the <br />pe�fomiance o/ consiruchon. Thaf 1 arn authonzed by the o�rner o/ Ihis property to perlomi the <br />work lor which applicalion is made and 1 cemply �vifh the Sfate CenVacfors La�v 18.27 RCW and <br />296.200 WAC. <br />_ � "' <br />� _ ( � � � � � <br />. ��'""_ . � <br />FEE <br />„-� �L'�-i(:L <br />/' /�/ '� <br />� %//� � <br />