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I ELEC1"RICAL 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 /> APPLICATIONS ARE ACCEPTED FROM 8 Ah1 TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> PROJECT ADDRESS <br /> Owner Mail Address City State/Zip Phone <br /> � J' <br /> �.,:� � �;:��,,i�� � j�r �74 ,1;; � c � �,— r rc�« l�v.,� �.�%1�1t �� `�� �? � <br /> Tenant Mail ACdress City Stalo2lp Phone <br /> -���. NI� , - IC �� NC� - _ <br /> r ( <br /> �-s� 3 �->^ � �p� � i�� � ��1�-,-� ,_I �,���-� �r ���,� �'� � � �, ; ��,_: > ; :�,i , 3 <br /> Electrical Contractor Mail AdOress City State2ip Phone <br /> f-�WNkc, ��� �i ���' '1 �� � aa� >. � ., „ <br /> Sta e License Number Contract Price of Work <br /> 1.�•> ;� 1`t.�'��.�" <br /> Proposed Use of Building Contact Person (Plan Review) � <br /> Description of Work to Be Done: _ (C'c� / ?��Y ?,�����1' ^ 1�,-„����j �'�-� l�; { <br /> ,�. � I <br /> ;1�. I I II� �t,7< < I�-`..i) I'/i.'l�t, '���5 �i� 11 <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 <br /> I here6y ceRily that 1 have read and ezamined(his application and know the same to be true and <br /> correct. All provisions of/aws and ordinances governing this type ol work will be comp/eted <br /> whether speaGed herein or not. rhe granting o!a permit does not presume fo give authonty fo <br /> vio/ate or cancel the provisions olany other state or local law regulating constn.�c6on or the <br /> performance oI consVuc6on. 7hat I am authorized by the owner uf this Hroperty to perlorm the <br /> wcrk for which applicatien is made and I comply with Lhe Slate Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> - � - % %'ll � ;� <br /> � S�onature� `---- Date <br /> �a5a! -D�L <br />