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ELEC;TRIC,4L PERMIT APPLICs4TIO�V <br />CfTY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 ���-� ��j <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org � � Sp �` /3 / <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS AR[ NOT ACCEPTED <br />�i�,V� (i � — � "�'i '✓�� � i . C `! t. � C� `i �, � , <br />PROJECT ADDRESS -� ,_� J <br />1 � 1 I � -, v� } , , ,� �_ �� c��r <br />Owner <br />Tenant <br />� �' J '-', A� -1 �'`� '�J Q, <br />ElecUical Contractor <br />-� c; � �{ <br />Mail Adtlress <br />Mail Address <br />i���; s�, E� � ���-�H <br />l� l o �:_ r r 1 1 <br />Mail Address <br />l, �— <br />'� � �' -� t ; r .� �., �; � <br />State License Number <br />' � I��,��.�) <br />Proposed Use of Building <br />Ci�y <br />� <br />City <br />����J 1 ��?,�" ��G <br />- , , ,� <br />Descriplion of Work to Be Done: •�- '� �.% �� <br />NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO <br />BE IN RACEWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />C� u.U��n� �,«.� <br />� 1� o Vt Vl i� )� I'�� (�,' <br />� ��OL�- -�zti�•�( j` <br />Slate/Zip Phone <br />Sla�e2ip <br />r; )_ I��,tn; i 1� r�'� <br />Phone <br />City State2ip C V�.� �'�hone <br />��U li �`'i l <br />- �/ 7" <br />-41' �,�.'7�:� I� h.D � u S fiG4C <br />Contrect Price of Wo 4? 5_ <br />�����Q1pYJJ�'�� ".f;�,`%;`;Z.' <br />Contac�Person (Plan Review) <br />r <br />�� �,��i l� <br />1 hereby certily thaf 1 have read and examined this application and kno�v the same lo be true and <br />conecL All provisions o/laws and ordinances govermng this type o(work will be completed <br />whether specilied herein or not Th? gran(iny of a pennd does not resume to give authonty to <br />violate or cancel the provisrons of any otlier slate or local law reguPting cons(ruction or fha <br />peAonnance ol consVuc(ion. That 1 am authorized by the owner of thrs property to perlorm fhe <br />wark lor whicn application is made and I comply u�ifh fhe Stafe Contrar,tors La�v 18.27 RCW and <br />296200 WAC. <br />� <br />� — .^, "�'�(��� <br />� <br />V \iil b"�, '� l- <br />FEE <br />,tr— <br />