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EL.ECTRICAL PER61lIIT AFPLICAT�UN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVEREI7, Wa 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />�J�Z�v L=v'—c/'�C-,2C—�.:N Wr'�''� � C�"�� �' i� �`� � <br />PROJECT ADDRESS <br />ILC— � <br />Owner <br />AN1� S�m c- <br />Mail Address <br />City <br />State'Zip <br />( ��q `'3 <br />C> 1301 �16� <br />Phone <br />1��= �1 3RnnL ���� �. <br />Tenan� Mail Address Cily Stale/Zip Phone <br />Loe �� b � <br />SGQi11�1�1E�— �L�/TF'�1L P'�''�ii0 f��k VwOAvvi�� L,�� �j�07Z c%`�v`-( <br />Electrical Contractor Mail Address Ciry SlatelZip Phone <br />SG�'l(3� I �?S3 I�v� <br />State License Number <br />D M w� - <br />Proposed Use of Building <br />Square Foolage Qf residential new consiruclion, remodel or addi�ion) <br />� <br />i� ?�� <br />Conlract Price of Work <br />�l� J l'f"E�✓� �� <br />Conlact Person (Plan Review) <br />�Zc7� ) % ( �S- -� 9 v `f <br />Uescription of Work to Be Done: a S CJN �-1_.=f�T A'T� p` N� <br />�:I I%L-v �'(— �� ;!1 � J p. w` (� Gl �2.t,'l l <br />NOTE: WIRING IN NON-DWELLINGS IS REQUIRED i0 <br />BE IN P,ACEWAYS, NiC OR AC CABLE . <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />iiPL-iL�l:- <br />� i 2� AM'1�0 <br />lliereby cerii/y fli�f 1 have read nnd examined this applicalion and know Ihe same to be tri�e and <br />co;iecL All provisrons of la�vs and orclinances govemmg this type of n�ork tvill be completed <br />�:-helher specihed herein ornoL The granfing o/a pemut does nof preswrie to give authonty to <br />violate orcancol the provisions olany otherstate orlocallawregu�ating consVuchon orthe <br />perfonnance of cons(n�chwi. 7hat 1 am authonzed by Ihe o�vner of this property to pedorm the <br />n�orlc for v✓hicl� applica(ion is made and I comply witli the Stale Confractors La�v 18.27 RCW and <br />296.200 W�C. ' <br />�%�� -� - ' /�5 %� 3 _ _ <br />FEE <br />� U��� <br />�(3�(�/60 <br />