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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - �AX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />',�I�� 132•.��5 I S� 7t= D <br />PROJECT ADDRESS <br />( tySi <br />' ✓�+ y �'y �p/ ( <br />�� �-��llA.o'li :-�i.� �_���ll�U'1 �Vo� �LIGr���L � L� d5> %di'l <br />OWner hlail Addross Qty State�Zip Phone <br />11'I A1 l� �us � �•� <br />Eloclrical <br />Mail Address <br />'�'�-� � ; ���� � �. <br />r Mail Address <br />, <br />i7c'.'�V/ �7�;iA'� � � <br />State Licen e Numbcr <br />Froposed Use ol Building <br />�� S7-SE �� �=v�� �� <br />Ciry <br />L—'i' �-[1d���(=$�0.� ��.\ � <br />Clly <br />rhone <br />�V .� � �t�l ''17J � ! "I(-- <br />Slale/<'ip Phone <br />f����� nv _ <br />CoNracl Pnce of Work <br />�" � .� ��✓i,��'ll C.CJf i <br />Conlact Person (Pla� Reviow) <br />DescriptionolWorktoDcDonc: ��j-�1��� � �•Ic�v,,,;� // /�'f/?'dS ru` r7e{'f'Jv�..� ,'«Ltw�_� <br />�,,,� ; , i f , , ., -1-�� � �,� � � , f- ,,., ���.�.. L�. <br />NOTE: W IRING IN NON-DW ELLINGS IS REQUIRED TO <br />E3[ IN RACEWAYS, h1C OR AC CADLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS �105 <br />1 hrreb�� crndy- fhat 1 haec rend and e.amined tfus applica6on end kno��, fhr san�e fo be t�ue and <br />��onrcC All prnvislons ol/aws and ord�nances governmq fhis type o/�•.ork u�ill be complefed <br />�rhrfher sper.A�ed herem ar m L Tho qrontin� o! o pernirt does nut/vesume fa �Jive aulhorrty �o <br />violnle or cancr,l lhe pro��isions o! any ofhe� sfate or I��cnl /a�ti� regu ating censtrucfion or fhe <br />performance o! conshucf�on. That I am aufhonved by fhe owner el fhis prnperty to peAorm fhe <br />�vork lor which applicafion is m;�de and 1 cnrnply with fhc Sfafc Conlir.c(ors Low 18.27 RCW and <br />296200 WAC. <br />� , i; __:�i ��_���z <br />FEE <br />.� <br />