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; <br /> ELEC7RICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857-www.everettwa.org <br /> APPUCATIONS ARE ACCEPTED FROM 8 AM 70 4 PM -DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> �0 3 �s �s,� � R.vr+D � lD2 <br /> PROJECT ADDRESS <br /> OWner Mail Address Ci�y . State/Zip Phone <br /> � nEl,�,so� S��s Io3�5'Fkw�+c. 2.� � /� 98�1 �lis-sa�-ssiw <br /> Tenant Mail Add�ess City State/Zip Phone <br /> ►ksFrc Co�ST I.u�cacaG� Po cu� A� U�oe,r�.�.au.c �,�A 98o'Iz �lK-y)1-cooi <br /> Electrical Cont�actor Mail Address Ciry StalelZip Phone <br /> 1�AP�F� o �lu D , '� �—`� � <br /> State License Num er Contract Price of Work <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Description of Work to Be Done: ( )rN/�Oh��J'T'Qi1�1`f�dA1 4.Lc,�+�a� �[Yv� � <br /> � .��,-xLu,� <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RA�EWAYS, MC OR AC CABLE. <br /> 3s� oa � I <br /> qTY OF EVERETT LOGAL SALES TAX CODE IS 3105 i <br /> I hereby certily that i have reac and examined this appVication and know the same to be true and �I <br /> correc[ All prov�s�ons o/laws and ordinances govem�ng this type of work will be completad I <br /> whether specif�ed herein or not The granfing o/a permrt does notp resvme fo give authonty to <br /> � violate or cancel the provisions ol any other state or local law regu/ating consiruction or the ', <br /> � peAormance o/construction. That/am authorized by the owner o/this property to peAorm the '� <br /> work for which application is made and I mply with the State Contractors Law 18.27 RCW and i <br /> 296200 WAC. <br /> S�gna Date ��� �� � <br /> E �� <br /> R � <br />