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i <br />C <br />ELECTRICA� PERIViIT APPLIC/�TION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />� �2S �ve✓-�ee� �/lict �/ ����c. �' <br />PROJECT ADDRESS <br />Owner <br />Tenant <br />Eleclrical CoMractor <br />Idail Atltlress <br />.n� <br />A1ail �tltlres; <br />�'n� LLrf.� lEti f nc� I, �. �'C <br />6+aa na ss • <br />�',�M.�t��rM�S�� <br />State License Numb r <br />���-�'. � <br />Proposed Use of Oudding <br />Descripfion af Work to Be Done ��� <br />NOTF WIRING IN NON-DWELLINGS IS REOUIRED TO <br />BE IN RACEW�YS, MC OR AC CABLF. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />Ciry <br />Cily <br />Cdy <br />$Ia1C7Zip <br />Slate�Zip <br />��l <br />Slate2ip <br />%ff—�o� ll <br />G-illD���� <br />V`�'_' <br />Contracl Pnce of Work <br />Contact Person (Plan Revlevq <br />1 he�eby cwtily Ihaf 1 have road and examined Ihis applica6on and know (he same lo be f�ue and <br />correc! All prowsions ollaws and ordinances governmg fhis type or r�ork wdl he compleled <br />�ahr, fhcr specdietl hmem or noL The 9ranling oI a pernu! does no� p�esmne lo give au(hority fo <br />viola(e oi cancel Ihe prowsions ol any ofher stnfe or Inc��l law re9ulabny constiucl�on or Ihe <br />peilormance o! r.onsfrur.hon Thal I am aulhonzed hy fhe owncr ol fhis propeny lo perlo.rn Ihe <br />wo{k !or which applicalion �s matle and 7 comply v�dh Ihe Slale Conlraclors Law l8 27 RCW and <br />, 2�_ <br />FEE <br />Phone <br />Phone <br />Z' <br />f�i �2y3 <br />Phone <br />