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9-9iel <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES 1 i ��6_ pl <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org Ur 6 (( O <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />OZ A'D y i' Avg__ <br />PROJECT ADDRESS <br />Owner ail Address City StateOip Phone <br />Tenant Mail Address City State/Zip Phone <br />G%-t lv� ZAP SG't ax ['J 01,jA.l<, T,,/. LJyt- '!Y0`/3 <br />Electrical Contractor Mail Address city State2ip Phone <br />112 T 67.2 - 6-7 f7 <br />ELEc r. y Ito 34 -Soo <br />State License Number Contract Price of Work <br />Proposed Use of Building Contact Person (Plan Review) <br />Description of Work to Be Done: 1;0J. r o wu <br />re <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 1 have read and examined this applicath, n and know the same to 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 pnrmd 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 />performance of construction. That I am authorized by the owner of this property to perform the <br />work for whit applica ion is made an 1 comply with the State Contractors Law 18.27 RCWand <br />296.200 W <br />Signature Date <br />