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ELECTRICAL PERMIT A►PPLICAT�ON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETf, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> ' , ' 4, ;;-�'( i;?r c i 5 i� L_(� <br /> PROJECT ADDRESS <br /> � <br /> ; r_ �, <br /> � �h(1 G1 � L' �V L G� '.'v l`�/✓�. :� lj�T l 'J /-6-1 l�7 � ���.,r L � <br /> Owner Mail Address City � � StatelZip Phone <br /> Tenanl Mail Address City State2ip Phone <br /> ��- 1=� � <br /> EleCtriCal Contracior Mail Address City � State/Zip Phone <br /> State License Number Contract Price ot Work <br /> Proposed Use of Building Contact Person (Plan Review) <br /> � � _� ! � <br /> Descriptiun of Work to Be Done: i ; <"l S I� '�/7 5 / �' <br /> NOTE: WI�ING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, nAC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> �c5���4 - I(�3 I <br /> 1 hereby certily tha(1 have read anJ examined this application and kno!v fhe same to be true and � <br /> conect All provisior,s ol laws and ordinances govermng th�s type o(work will be completed <br /> whether specihed herein or not. The gianting o/a permd does not presume to g�ve auihonty to <br /> violate o�cancel the provisions of any other state or local law regulating construeGon or the <br /> perlormance o/ccnstruction. That I am authorized by the owner o(this property to perfomi the I <br /> work lor which application is made and 1 compty with the State Contractors Law 18.27 RCW and <br /> 296200 WAC. I <br /> � <br /> � ' • ` c' I <br /> .c�:,E.'_ � , � CZ � �L��..�.� �. -.�(.5 � a � <br /> SignaWre Date <br /> I <br /> —_ _ � <br />