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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES IV_2%;x_4j <br />3200 CEDAR STM:T, ZJERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />S t �vefe 1� �1 S2o 1 <br />PROJECT ADDRESSZ� _t <br />Owner �` II Mail Address City StateOp Phone <br />Tenant Mall A ress City Stateop hone <br />11.. c- <br />�•\\ �C�p �.`l l `'� Q', s\ S� G -�-r�� c� �t -•�N U.;� �t42 ��-+z-<� -i-�- <br />Electrical Contractor Mail Address City State/Zip c6_6 b Q'Phone <br />LA <br />�a-'cc) ,()-n o0 <br />State L ense Number Contract Prike of Work <br />Proposed Use of Building Contact Person (Plan Review) <br />Description of Work to Be Done: <br />i <br />P <br />NOTE: WIRING IN NON -DWELLINGS IS REQUIRED TO FEE a <br />BE IN RACEWAYS, MC OR AC CABLE. I <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 <br />whether specified herein or not. The granting of a permit does not resume to give authonly to A <br />violate or cancel the pprovisions of any other state or local law regulating construction or the �[ <br />performance of constmction. That I am authorized by the owner of this property to perform the O I <br />work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />`na <br />Signature Date <br />