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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES � <br /> 3200 CEDAR STREET, EVERETT, WA 98201 I <br /> 425-257-8610 - FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FRflM 8 AM TO 4 PM - DEBIT 8� CREDIT CARDS ARE NOT ACCEPTED <br /> :-' �1�J' ho:✓v lr, <br /> PROJECTADDRESS <br /> �=/'ic� ,Pvc,�r>L' 2915' b��,v� S�. <br /> Owner MailAddress City State/Zip Phone <br /> Tenant Mai�Address Ciry Stale!Zip Phone <br /> �7/LiLr �NCT/�/G , �c. , �C' �X /3D�' /UDN.�'c�N ��fJ ��`�'<'77- y��'_YC�- n• 7 <br /> EleclriCal Conlractor Mail Address City � Slale2ip Phone <br /> /ti/,l�1C ET/nl Pl� � �D� <br /> State License Number Contract Price of Work <br /> I� U7� �G-f�/� - <br /> Proposed Use of Building Contact Person (Plan Review) <br /> �� �i, <br /> Description ot Work to Be Done: �-iUfT/1zr- I�/'.���� �� /•t�-� �'/,�/M r pc�<^%�j' <br /> f�/,�d - 6��kC-�-�a `� �ri r,.�c�� tia �.e V��LS' /�L7L.�OT/6 i�✓ <br /> NOTE: NJIRING 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 /> I here6y certify fhat 1 have read and examined this application and know the same(0 6e true and <br /> carrect. All provisions ol/a�vs and ordinances govemin�this fype of work will be completed <br /> whefherspecified herein ornoL The granting o(a pem�it does not resume to give authonty to <br /> violate or ca��cel the provisions o/any ofherslate orlocal law reguPting construction or the <br /> perlomiance o/consfruchon. That 1 am authonzed by tho owner o/this property fo perfomt the <br /> woric lor�vhich applicafion is made nnd 1 comply with fhe Sfate Contractors Latv 18.27 RCW and <br /> 296.200 WAC. <br /> t <br /> �i _ /'//��' � /7/1�� <br /> Signalure Dat <br /> ,�c`i �c�7 - 7 v <br />