Laserfiche WebLink
ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETI�, WA 98201 I��� 8� <br />425-257-8810 - FAX 425-257-8857 - www.evereltwa.org C'D� �� �(� <br />APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM <br />i�� C� 7 �1 ��f � c t 5� �� r 7 <br />PROJECT ADDRESS <br />_�/�J1` �f�i,)',�� �.n�_ �������1�/�(�.'//�'��i:l <br />�WIIQf 1.{:111 PddleSti (llly <br />Ten�inl <br />1.1atl �ddmss <br />Cily <br />/: <br />��It1 <br />�'� <br />Stale'Zip <br />tilatr�;Lp <br />Jl2�C 1 Z 7S �� <br />Phone <br />Phone <br />��r,�i�� �1��N�,c l-;< �l�Ok /I<,!� /lljllCr�.l< <>�UFZ �/�� 3;��jF; <br />Eloclricnl CoNracbr Wail AdAress City Slale2ip Phone <br />( <br />� �"�"i`iihN{— <br />State Licens� Number <br />�\ I c, , � <br />_ >,,�� ��� �����.-�1� �,.,.���� <br />Proposnd Use n� OuilAm9 ' <br />Description ol Work to Oo Dono: <br />1 �\/ �, <br />'V a"� `[%�'�� <br />NOTE WIRING IN NON-DWELLINGS IS REQUIRED TO <br />DE IN RACEWAYS, MC OR AC CABLE. <br />CI7'f OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />y1 �v <br />Coniract Prico ol Work <br />� � <br />Gi r� %% �' -.; � <br />Contact Person (Plan Roview) <br />� <br />1 hnrebp r�v6fy Ihut I hnv� read ,ind c�sanuneA fhrs npp6cnfion and knmv fhe same fo be truo and <br />conecf. All proviswns o! liws nnd �vdinuna�s gar�rnmg fh�s type o/ worA wdl be cornpl�fed <br />�rhrfher sperdmAherein or rrof 7he �r,�nhng o! n pernuf does nol vesume to �ive aufhonty fo <br />��iolnfe o� cnnrnl Ihe (�rovlslons nl anv olher stnfe o� Incal law �o�u��6n4 conshuchon or tho <br />porfonrr.�nc� o! cnnstiucfion. L..rt I am aufhurized by the owner o! fhis property tu perlorrn fhe <br />worh !nr which app6ca6un !s niadr and I uomply a�ith the Stale Con6nclors Law 18.27 FCW end <br />2f)ti 200 IV�C. <br />nG/i.,.�.t�.. /�H.�r� <br />FEE <br />.. �I�1'��'�"1 <br />1� <br />