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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 ;E:DAR STREET, EVERETT, WA 98201 <br />425-257-88,C - FAX425-257-8857—www.everettwa.org C070q-16 <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PROJECT ADDRESS �] <br />�0j jCt•t� --Ark �1 <br />Owner Mail Address City State/Zip Phone <br />sr It tc� rlo �IS"1 << 0E"��c711( Cyi1"q,/ A(A- 5l)Wt 30t> rx/L'rrf+'I'L,W4o' <br />Tenant / Mail Address City State/Zip Phone f <br />CLIAA,V <br />Electrical Contractor Mail Address City State/Zip Phone <br />2 0 � ro <br />(1 �� <br />State License Number Contract Price of Work <br />N I 11A t r r <br />Proposed Use of Building Contact Person (Plan Review) <br />/ ,I¢�n J <br />Description of Work to Be Done: � 1 Cn Ckil { C'� �L' � �EL-1 � � �T�-t c <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 application 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 spewed herein or not. The granting of a permit does not resume 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 roperty to perform the <br />work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and <br />296.200 VA4C. <br />if ,�310�' <br />Vignatur J Date '% (/ <br />