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8i6 <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 - www.evereltwa.org d <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PROJECT ADDRESS <br />t,je✓f4+ Elks (f(,� <br />Owner Mail Address city State2ip Phone <br />Tenant Mail Address City State2ip Phone <br />y 2_f <br />�(ec�✓I• Ct4y lv.e_ Z3oo8 S6612.67 <br />Electrical Contractor Mail Address - city State/Zip Phone <br />ELEcTj -Y 110 804 Ifsgg2 '00o <br />State License Number Contract Price of Work <br />Elks C1o6 , Jl 9 co`.Pta Aa�oll,' M&4. l.• w <br />Proposed Use of Building Contact Person (Plan Review) <br />Description of Work to Be Done: A)* U-) eo S l`I JL�i Oln - lei c I 0 ar k r <br />2 - 12," 15 To, HLs CI l 3- r(r 'j4.s1N�+,�1 �9UVIT+J <br />�I <br />NOTE: WIRING IN NON -DWELLINGS IS REQUIRED TO FEE <br />BE IN RACEWAYS, MC OR AC CABLE. <br />GITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby certify that 1 have read and examined this application and know the same to be true end <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 />performance of construction. That I am authorized by the owner of this property to perform the <br />work for which applica on is made and I c iply with the State Contractors Law 16.27 RCW and <br />296.200 WAC. <br />/0/ 7 /f 7 <br />Signature Date <br />