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I <br />ELECTRICAL 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 C0+1117i�` j 1 <br />APPLICATIONS ARE ACCEPTED FROM S AM TO 4 PM <br />c Sod rJryei <br />PROJECT ADDRESS <br />Hzs-931- <br />p5ovic�.l_ �s36'S Reve L., Ctit'n�1 IJA�jg2oS <br />^.v Mall Address City Stale/Zip Phone <br />V�Iller <br />Tenant <br />Mall Address City Slateop Phone <br />QAEc ClPr,41'c /10 gcx M-f. Venn. U4ef&'2-?3 3i�c-Y21 <br />EledricalContredor Mall Address City <br />StateZp Phone <br />GI L) ; a F `� )12 c �12�2`l%/Z\Jj I bo o <br />Stale License Number / contract Prue of Work <br />Proposed se of Building Contact Person (Plan Review) <br />Description of Work to Be Done: A I - e rta <br />NOTE: BE NON -DWELLINGS REQUIRED TO <br />IN RACEWAYS, OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />FEE <br />J. <br />/ S <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 -)romances poveminpp this type of work will be. completed <br />whether specified herein or not. The granting ofa perm7f does not presume to give authority to <br />violate or cancel the provisions of any other state or local law regulating construction or the I I <br />performanceof construction. That I am authorized, by the owner of this property fo perform the <br />work for which application is rnad� comply with the State Contractors Law f 3.27 RCW and <br />296.200 WAC. <br />TZ - / D <br />8 <br />gust Dale <br />75 <br />