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ELECTRICAL P�RMIT APPLICATiON <br /> CITY OF EVERETT PERMI7 SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 982Q1 <br /> 425-257-8810 - FAX 425-257-8857—www.everettwa.org �� '� �'J�7 <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM C U � �� ��3`l <br /> 32.3 � LoM3�� Au� . <br /> PROJECT ADDRESS <br /> l�rk�+� (�tkl��e.sDN 3z3� Lomaaa�o ,A~,r� Fa,�.rr�Ti- �/z.s �3za - 7gz <br /> Owner MailAddrass Ciry StatelLip Phone <br /> Tenant Mail Addres, City Statc2ip Phone <br /> ' ItiH►3 <br /> E � Gl1kTR�F� �.•`_ ".T.C�S �l� U+�y L.a+�NwooD ZOln-S'I_9_331 <br /> —� ��y, � S1a��2iP Phone <br /> ElecfricalContracror �Ma��add�ess <br /> � '750� <br /> ��V"^�TS� ���L� Contrad Price of Work <br /> State License Number <br /> f f'�W 0���-C-� <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Description of Work to Be Done: 1"1�0 N� ��5 A�) S���T�''� 5`�S' ��''� <br /> _i' ✓ I '�� <br /> NOTE: WIRING IN NON-DWELLINGS IS RE�UIRED TO FEE I �, <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> � Iil <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certiFj fhet 1 beve reed end exemmed this epplicetipn end Imo�v the same to be frue end <br /> correcL All provisions olle�vs and ordinences govemmg this type o/work�vi/I be rnmpleted <br /> �vhether speci6ed herein or noL The granfing of a permd does notp esurne fo give eulho�ity to <br /> vialafaorcancelfheprovivonso/anyothersteteoilowllawreguleting�P�ctio�rfhe <br /> performence olconstrucfion. 7hat I am aufhorizedby the o�mero(fhis e to Aorm fhe <br /> u�ork/or which pplic tion rs made end I compty with the Sfete Contrectors Lew 1827 RCW end <br /> 296200 WAC. <br /> - - il -Z�-o� <br /> __ __ - ---- ----------- <br /> � Signature Datc <br /> r. 0.-�I � ' � ?�� <br /> I <br />