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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />A25-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />�� `t 't � � c.� � <br />PROJECT ADDRESS <br />Owner <br />Tenanl <br />�///✓ i <br />Conlraclor <br />Slalo Liconso Number <br />� �3� z F � -S 5� <br />,«. <br />Wml AAdress <br />Mail AdAress <br />� <br />�'T.f <br />A7ail Address <br />�//�G�C C �1,1. r� y <br />ProposcA Use ol Duilding <br />Dascrip�ion ol Work lo B� Done: <br />NOTE: WIRING IN NON-DWELLINGS IS REDUIRED TO <br />BE IN RACF.WAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS �105 <br />Cily <br />Cily <br />Cily <br />s����,z�,, <br />Slale/Zip <br />Stale/Zip <br />Phonc <br />Phone <br />Pheno <br />�`7� OC70 _ <br />Conlracl Prico ol Work <br />Contacl Person (Plan Roview) <br />L� <br />I hereby �:crtily Ihat /Irave rend anA eenmineA fhis appbcafion end know fhe smne to be Vue nnA <br />correcl. All provisiuns ollaws nnd ordmnn�es govermng this fype ol work will6o complefed <br />whefher specilied herein or nof. The �ranfinc� o! a pernuf Aoas nofp rosume tn give nufhonty to <br />viulate or cancel fhe ruowsions ol �ny olhe� sfato or local law re[�ulafing constn�ction or fhe <br />perlormance ol constniclion That I arn aufhorized by fhe owner o/ Uus property fo peAorm fhe <br />work lor which appl': A(1011 IS 1113AB Bfl(1 I rnply wilh tho Stafe Confrocfors Lew 18.27 RCW and <br />29G.200 WAC. �., .. -- <br />-/2 - 0'7 <br />FEE <br />,7 D-� - % ) <br />