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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />CEDAR3200 425-257 8810 FAX 425-257 8857 - www ev�� S-D7 <br />erettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />2goi f ra,4 AyV , <br />PROJECT ADDRESS (f <br />��Vc� .l✓�} �2-f <br />Owner Mail Address City Slate/Zip Phone <br />Tenant Mail Address city State/Zip Phone <br />D41n�✓ <br />Electrical Contractor Mail Address city State/Zip Phone <br />ISvo,t;,a _ <br />Stale License Number Contract Price of Work <br />Proposed Use of Building Contact Person (Plan Review) <br />Description of Work to Be Done: r4- -e e4 L = S v r <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 I 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 0 `"O O <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 roperty to perform the <br />work for which application is made and I comply with the State Contractors Law 18.27 RC W and <br />296.200 WAC. <br />4 - j lQ o <br />Signature V Date <br />