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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STPEET, EVERETT, WA 98201 I�- �S'"�� ,,) <br />425-257-8810 - FAX425-257-8857-www.everettwa.org C���Z��52'j <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />2 S z.� /o "' -S� <br />PROJECT ADDRESS <br />/� / ���� �!E ��o�����y ��� /��,�s�o G,/.; S&379 yzS 3�$-7�, <br />T�ts /�%l�/•,,� <br />Owner Mail Address J City Stale/Zip Phone <br />li ✓n � Z S Z� /q r5 Sf tJiCr�/� <br />Mail AGdress ���Y <br />v�io•, t/o<fn� �ti� !°Q Clrne. Z7o �u�,f�,�a <br />Eleclrical Conlrac�or A1ail Address Ciry <br />v1 sro�--��9o-s� <br />Stale License Number <br />�eti yl ,lo--�' <br />Proposed Use o( Building <br />Descriptior. of Work to Be Done: _'' <br />l% L'-, �<�° �� <br />G✓-, ��S7L�,3 <br />Slale/Zip <br />r„,� ��, S�'o y3 <br />Slate/Zip <br />� y�po .o� <br />Contract Price of Work <br />Phone <br />97s S64-zz o <br />Pnene <br />Tko..,...s <br />Contar,t Person (Plan Review) <br />(L � HC/ Ac.E �O �oc�S<' �`'�. <br />NOTG: WIRING IN NON-DWELLINGS IS REQUIRED TO <br />BE IN RACEWAYS, A4C OR AC CAB�E. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 heieby certily fhat 1 have read and exarnined ihis application and kno�v fhe same to be frue and <br />correct. All provisions of la�vs and o�dinances governmg fhis type o( �vork �vill be completed <br />�rhefher specified herein or noL The grantin� of a pernut does nof resume to give aufhonty fo <br />violafe or cance/ the provisions o/any ofher stafe cr local law reguPtinc� construchon or the <br />perforrnance of conslrucfion. That 1 am aufhorized by the o�vner o/ this �roperfy to per�orm fhe <br />wo�k lor which applicafion is made and 1 cornply �vith the State Cont�acfors La�v 1827 RCW and <br />296.200 WAC-=� <br />i � <br />��- /.� �o� ��� <br />FEE <br />� � � �2- �.�� <br />