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�LECTRICAL PERI,IIIT APPLICATION <br />CITY OF EVERETT PEFtMIT SERVIC�S <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 - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />�/.,3� �'v.c.� ;Pi�_F,r/Gt/f�Y <br />PROJECT ADDRESS <br />0 <br />��✓e �i/�i° i ,4n �,uE,eJL�G �'7S c3l�r/_R.%.,-F zY�`r �Fufocr if/�' �' /cvi� <br />Ownef �����J MailAddress Ciry Slale2ip Phone <br />�J`? � <br />O��C''92E �? z3 �����,�.�y �vE.�-s� ��%st �lY<9 3rat-x.00 <br />, <br />Tenant Mail Address City Stale/Zip Phone <br />C�.f//T� Ff-��7-.C/iz ."l3�% �vi.�. 2'v�j�./� F✓.��Yq' Cc%.2 7S1u7 `� 2�.1-iY.!. <br />Electrical Contractor A4ail Address Cily Stale.2ip Phone <br />�i/.7FEci7G/�JG <br />State License Number <br />�Fficf_ <br />Proposed Use of Ouilding <br />Description of Wark to Be Done: /L�r.✓ /3y�� Z�-✓y G'�l'i�=QE <br />NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO <br />BE IN RACEWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TA:C COOE IS 3105 <br />I hereby certify that I have �ead and <br />correcL All provisions ol/aws end o <br />whetherspealiedhereinornoc Tf^ <br />viofate or cancel the provisions „nr <br />perfomiance o( construclion. i hat I <br />work for which application is made a <br />296.200 WAC. <br />/ <br />% i // <br />nr/ _ <br />� ��0�� <br />Conlract Price of Work <br />Contact Person (Plan Review) <br />this application and know fhe same to be true and <br />govemmg this type ol work wi116e comp/efed <br />�l a permif does not presume (o give aufhordy fo <br />3te or local law regulating consfruction or the <br />ized by (he rnvner of fhrs propeRy to peAorm fhe <br />N with the State Contracfors La�v 18.27 RCW aad <br />� � �C> - �S ��� <br />FEE <br />