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) <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857—vwvw.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> �3 c� � Sm ,�`ti �� <br /> PROJECT ADDRESS <br /> OWner Mall Address City State/Zip Phona <br /> Tenant Mail Address City State/Zip Phone <br /> uH,,- a �Z,-S,� ,�E s <br /> �x-rr,�,h „Z ��J+G�tiy-, I-12 7 F ina ri.tiy �/i�tw d. �-e-��rf- �F1S 9�P 20 1 <br /> ElecMcal Contractor Mail Address City StatelZip Phone <br /> c-xrRtP � � 9 � c. � � zs���"- <br /> State Llcense Number Contrac Price of Work <br /> 1 � <br /> �—��jClr r�'�c� <br /> Proposed Use of Bulld(ng Conlact Person (Plan Review) <br /> Description of Work lo Be Done: 1�1 S�4(� �'h�" o't � �� c�e" ��•"'t/G S <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO �E <br /> BE IN RACEWAYS,MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby certi(y that 1 have read end exemined fhis opplicafion and know the seme to 6e frue and <br /> correct. All pmvislons o(laws and ordlnances goveming this type of work will be completed <br /> whether specified herein or nof. The grenting o/a permit does not presume fo glve authority to <br /> violate or cancel theI�rovfsions o/eny other state orlocal law regulatfng construction ar the / /^� <br /> peAortnance o/constructlon. That 1 am aufhoriz3d by fhe owner o/thls property to peAorm fhe �I 1 I G <br /> work lor which applicaflon Js made and 1 comply with the Stafe Contrac(ors Law+8.27 RC W end <br /> 296.200 WAC. <br /> c�, � � ��" I �' � ( <br /> Signature Date <br />