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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, V�'A 98201 <br /> 425-257-8810 - FAX425-257-8857—www.everetlwa.o�g <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> 3 �2� B��DVa� <br /> PROJECT ADDRESS <br /> FfG4ti'�1 �utct PA��•✓6n.S <br /> Owner MailAdEress C�ty StatelLp Phone <br /> IfiCQG�f �i� �cc��dfio,✓,�( MFO(u,✓F <br /> Tenant MailAEdress City Slale/2ip Phone <br /> �v�ira�S��J U/tA lis d6�3�1C4X6��s n�• SFA�'/�.F t�? 9�/09 (us)i82-o1� <br /> EI¢dricalConlractor � MailAdOress City SlalelZip Phone <br /> N�ToS�1�� 3 :� ZS-o.00 <br /> State License Number Co ract Price of Work - <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Description ot Work io Be Done: ��ST'� Oi✓F I�lNr.���.r/�� W,�.1�C $/�iN <br /> Co✓d�ct,.,J �a Aen� Ci�tcul� dY �711f+�S. <br /> NOTE: WIRING IN NON•DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SAIES TAX CODE IS 3105 <br /> 1 hereGy ceRify thaf I havo read and examined this applicafion and know fho same to Ge true and <br /> correct. All pravisions ol laws and ordinances govermng Ihis fype ol work will be comp/efed <br /> whetherspecifred herein or noG The granfing o/a pemvt does nol presumo lo give authonty fo <br /> violate or cancel fhe provisions olany olher sfafe or/ocal law 2gu7afing constnicfion or(ho <br /> performance ol nstru �on. That I am aufhonzed by fhe owner ol this property fo peAorm fhe <br /> work for which plica( n is made and 1 crompty wdh fhe State Contracrors Law 18.27 RCW and <br /> 296.200 WAC. <br /> C � <br /> 6-28`�` /r0 c., - � � �, <br /> Sign tu e Dale <br />