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it 0 <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 / �'0 �Od <br />425-257-8810 - FAX 425.257-8857-www.everettwa.org t�'-ao?-003 <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PROJECT ADDRESS <br />Lug) �FK - Ci r-1 <br />Owner Mall Address City StateOp Phone <br />Tenant Mail Address City StaterZip Phone <br />\(\f\ ,'11r� 1 �-V"r 1 G cf-) mac-• l // UOr, ter? ' �� q- <br />Electrical Contractor Mail Address City State/Zip Phone <br />Stale License Number Contract Prico of Work <br />Proposed Use of Buildi-g + , ^ /�,,� ,n Contact Person (Plan Review),i <br />Description of Work to Be Done: W l�� . \CQ ,J. '� cn k�\ ,'QY Ct cj— . b \\ u\�l� <br />llJ 1 A)i�i V I CSL � � - z C-I VA::"Q <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 />thereby certify that I have read and examined this application and knots, the same to be true and <br />correct. All provisions of laws and )rdinances guveming this type of work will be completed <br />whether specified herein or not. The granting of a permit does not presumo to give authority to <br />violate or cancel the pprevisions of any other state or local law regulating construction or the <br />rmance of construction. That lam auth riled by the owner of this roperty to petfomr the <br />perfo <br />work for which application is made and 1 comply with the StatE Contractors Law 78.27 RCIN and <br />296.200 WAC. n 03 <br />Signature Date <br />t <br />