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ELECTRi��4L PERi1�li AP��ICATI��f� <br />CITY OF EVE�ETT PERMIT SERV'ICES <br />3200 CEDAP, STREET, EVEPETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — �vww.everattwa.org <br />� �—�6--0 <br />APPLICATIONS ARE P.CCEPTED FkOM 8 AM l G 4 PM � Q g� Z_ �� � <br />�-: � <br />, .;:. 1 <br />, . <br />PR�JECT ADDRESS <br />O�mer <br />� BflHlll <br />i <br />� j�a:`� <br />nlail Fddrass <br />Mail Address <br />ji ; �%�.�'i.Y :.,. �:-_.1 J �:>�. iC,;_�✓. <br />[leclrical Conlraclor Mail Address <br />'_�,:Jri� �'G7�� <br />State License Number <br />i <br />/i- _ , ,' . , i � „ � <br />Proposed Use o( Building <br />`j l. , <br />Clly <br />Das�riplion of Work lo Cic Donc: �� . -. ''.. <br />NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO <br />BE IN RACEWAYS, MC OR AC CAOLE. <br />Cily <br />Ci�y <br />. . . '7 c' ;'_.. <br />SIa��/Zip <br />SL-:;��'7_iG <br />Phone <br />f'hcno <br />L.�� �=-LJ�� •�LS 'Z�C_�',.� <br />Slale/Zip Phone <br />�" �L�� ..' � -=� <br />Contracl Price of Work <br />Contacl Person (Plan Review) <br />CITY OF EVERETT LOCRL SALES TAX CODE IS 3105 <br />1 hereby certily fhat 1 have read �nd examined fhis applicafion and kno�v fhe same to be truo and <br />correct. All provisions olla�rs and ordinances goveming fhis type ol work will be completed <br />whether speci6en herein or not The granting cl a permd d��es nof pr�surne to give authonty to <br />violate or cancel the provisions o(any o(her stafe or'oca! law regulating construction or the <br />perlormance o/ consfrucfion. That I am aufhonzed by the o�vner o( this property fo pe�forrn fhe <br />work lor which application is made and I comply �rifh the Sfate Contractors Laiv 18.2? RCW and <br />296.200 WAC <br />� : , <br />— Si�uature <br />��.%/-�:�. <br />�, <br />FEE <br />���IZ. ��� <br />c. <br />....�.,.�...__.am�rl�i��w� - __ <br />