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ELECTi�ICAL PERM17 APPLICATION <br />CIT`l OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET EVERETT WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org a�-J5 ' �� <br />G)l� 2-06�1 <br />APPLICAl'IONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />� �f�% J J <br />���1'' ////i// �5�� <br />PROJECT ADDRESS <br />]�7 <br />/i Sr i� �1/�%!',�' �' % <br />Owner M 'I Addrer,s <br />j���✓ i,a.�y <br />�,�/J�r�� i1s <br />Tenanl IAail Address <br />� ��,5� i S � � 3� <br />EleMrical Contraclor fAail Addre�s <br />�- �'���- 6"i�'-S` ���'�� <br />Slale License Number <br />Proposed Use of 6uilding <br />r �, <br />Descriplion of Work l0 6e Done: -��/,i%✓1�< <br />�l F %�'F/ i <br />City <br />t�OTE: WIRING IN NON-DWELLING."i IS REQUIREG TO <br />BE IN RACE�VAYS, MC OR AC CABLE. <br />CITY OF EV[RETT LOCAL SALES TAX rODE IS 3105 <br />Cit/ <br />Y� <br />City <br />� �� <br />Stalc/Zip <br />Slale/Zip <br />Phone <br />Phone <br />1�1y�-��vv�i�� �i�D & � <br />Stale2i Phone <br />/'� ���% � j Q � <br />Contracl Price of Work <br />Contact Ferson (Plan Review) <br />�r F <br />1 hereby certily fhat I have read and exarni��ed Ihis applicalion and kno�v the same to be fruo nnd <br />correcL All provisions ol laws and ordinances povemmg fhis fype ol work will be comp/efed <br />�thether speaGeAherein ornof. The granting ol a perrnd does nut �resumo fo give au�kvnty fo <br />violate or cancel tne provisions ol, rry ufhcv state orlocal low regu/a(ing consWction or the <br />per(ermance e/consl�ucfron. Thal I am autho�ized by tfre owner oI fhis property to perlom� the <br />woik lor which applica(ion is rnade and 1 cnn�pl}� �rifh the Sfate Confracfors La�v 18.27 RC W and <br />2f76.200 WAC. <br />FEE <br />f;llC' � -CLr`� <br />�� <br />