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ELECTRIGAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-,f857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br /> � 72_ G R�nv�dWr�Y � �F_ <br /> PROJECT ADDRESS <br /> G-�?HUl3(o0 y i S <br /> ��vi-D/N��S 31Z6 ,��e�iDw�a� Fu,c�'�•-� fJ/� 9�' :�0• 7_lJ.=2�' 0 <br /> Owner Mail Address City State2ip Phase <br /> �.iRYtuT �Gp 37i6 gQ�1ROwnY 4 '�� <br /> �dc�-n�N�-S Ev�RE�� 1.��- 5520( 2�z- z ._ io <br /> Tenant Mail Address City State2ip Phone I <br /> Sot r:RS? !`�M�rv /-�JNROE I.�W 3�-� <br /> l S GlEiar�N�- G�. � 8 L7Z �Qc�-7'c�� <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> � v �� <br /> trS f�E/� L� UO � L > � � � I <br /> State License Number Contract Pnce of Work <br /> oFr�� E S5'l1�� r2o,v 1/�nPnR� <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Description of Work to Be Done: l 11.�`., �l ��L L �Z� T h��MV S� ��S <br /> u <br /> ��07 �-' <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> Bc IN RACEWAYS, MC OR AC CABLE. ��J <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceRify that I have read and examrned this application and know the same to be frue and <br /> correct. All provisions ol/aws and ordin;nces governing this type o/work will be completetl <br /> whether specified herein or not. i he granting o/a permd does nctp resume to give authority fo <br /> violate or cancel the provisions of any other state or local law regulating construction or the <br /> performance ol construchen. 7hat I am authorized by the owner o/fhis propeRy to peAorm fhe <br /> wcrk lor which application is made and 1 comp/y with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> �� y�.��'� �/� / � <br /> � Signature atA <br /> �- �- 7�. �-�� �� <br />