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ELECTRICAL PERMIT APPLICATION <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 />,� �� p`� (� ��� u G� �� � �� <br />PROJECT ADDRESS <br />� � u�' ����o���'� �e._ s t�. c'�Le►��� <br />Owner <br />e�s�or.� uo <br />Tenant <br />Mail Address <br />3�-la�'j MeDv� <br />�4rT� GN NO`OCO� <br />Mail Address <br />��( 1 � -() b't�-�U� <br />Electr cal Conlraclor Maii nddress <br />�N�o� <br />��tc� -� -'3�' � � <br />State License Number <br />`, � <br />�(S!�'L (,,tQ_ �— !� Ql' � � V`t l�. <br />Proposed Use of Building <br />Description o( Work to Bc Done: <br />5 u <br />J 5 <br />c. <br />2 1� <br />City <br />tiV�S���p (�"7 <br />���rP�Tt � <br />Stale/Zip <br />2oI <br />a <br />3�o�z�o-d�� <br />Clly Slate/Zip <br />9�5 `� <br />�I��e s��v �,..� i�z� <br />Phone <br />t}2 �S <br />z s�- �rZ 3'� <br />Phone <br />�!25�'_73 � �2'12 <br />Cily State/Zip Phone <br />��%f �J c-� <br />.Z ��.G �� � <br />Contracl Pricc o( Work <br />3 <br />, J �'E'-e � O <br />Contacl Person (Plan Review) <br />tMa;.�. Lv� <br />\-ch.�Cl ul <br />�� _ � � <br />� �- S �-�n,�P <br />NOTE: WIRING IN NON-DWELI.INGS IS RE�UIRED TO <br />DE IN RAC[WAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby certily thaf 1 have read n �d examined this applicafion and hnow Ihe same to be frue and <br />correct. All provisions ollmrs nrd ordinances governinr� tlus typc o/ �vork will be compleled <br />whefhcr speci6ed herein or noL The gr.�nling o/a pernut does not xesume to give aufhonfy to <br />violafe or aincel fhe provisions o�an}� ofher state or local law regul�fing constniclion or Ihe <br />performm�ce olconsfrucfion. Th:d 1 nm aidho�ized by fhe o�vner o/ fhis property to perfomt fhe <br />work lor �vhi � application is nr rie and 1 comply �vith the Sfate ConVacfors Law 18.27 RCW mrd <br />296.200 WA . /`� , <br />i �. � ! i r ,.. <br />� <br />FEE <br />1 c�f�'3 US`� <br />