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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 C 01 b 1 _/ 1 <br />PROJECT ADDRES <br />/l20z KM61/C y✓C <br />�VF W f.✓ W <br />Owner Mail Address City Slate/Zip Phone <br />Tenant Mail Address City State/Zip Phone <br />1.`NMJ S /4LO.J -.*12r- iucl!zQ Alm N �✓ i, r.J/4 <br />Electrical Contractor Mail Address ity tatelzip Phone <br />{ <br />'qao l it , 'fit-s it'f� c,c�,w r1 yaS-S�l { yri7 <br />,il k /1/Eo,4 10 , Pi? LIN _-�;Od <br />State License Number Contract Price of Work <br />sALoAj <br />Proposed Use of Building y Contact Person (Plan Review) <br />Description of Work to Be Done: t 5 % AL(— V L L 6' 6- XZ Z_ /fC 'l zr CW <br />nV CS <br />NOTE WIRING IN NON -DWELLINGS IS REQUIRED TO FEE <br />BE IN RACEWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby certify that I have read and examined this application and know the same io be true and <br />correct. All provisions of laws and ordinances governing this type of work will be completed <br />whether specified herein or not. The granting of a permit does not presume to give authority to <br />violate or cancel the provisions of any other state or local law regulating construction or the <br />pertommance of construction. That I am authorized by the owner of this property to perform the <br />work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />St§nature Dale <br />