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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.oro <br /> AP?LICATIONS ARE ACCcPTED FROM S AM TO 4 PM - DELiIT& CREDIT CARDS ARE NOT ACCEPTED <br /> fIL��L.TNFoR-G.E (>AfZTNE�2S cuN(L � P T <br /> 37 Z� SP-aaDwaY <br /> �v�2�r i <br /> PROJECT ADDRESS <br /> G/�Nu i FfOLD I�GS H L 5- 21 l -2 Z(O <br /> Owner Mail Address Ciry StatelZip Phone <br /> HEAL7HFeFCE Pr9R�NE2S ?�2C BKoADWAY Ec�f-12cTT kJ/9- QQlvr <br /> Tenant M11ail Address Ciry Stzte/Zip Phone <br /> 360 <br /> C� S NEHTIIJG CL1 .Ih�. SDv E/457 HAIAI H�N20� l.�r}- 4b 27L 794-�3d6 <br /> Electrical Contraclor Mail Address City State/Zip Phone <br /> GS �► � �acT bo5c5 2s, s �o °= <br /> State License Number Coniract Price of Work <br /> M �U i ��L L�- 1 �(/ r L `-I-��1�� <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Description of Work to Be Done: r lU S (�lL L. ��� f'S T!�"� S <br /> NOTE: W IRING IN NON-DW ELLINGS IS REdUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceRi(y that I have read and examined this app.'ication and know fhe same to be frue and <br /> correct All provisions ol laws and ordinances goveming this fype ol work will be comp/eted <br /> whether speci(red herein or noL The granting of a permit does nof resume to give authonfy to <br /> vio/afe cr cance/fhe provisions of any oiher state or loca/law reguPting construct�on or the <br /> peAormance o(consfruciwn. That I am authcnzed by the owner o/th�s propeRy to pedorm;he <br /> work/or�vhich application is made and 1 comply wdh the State Contractors Law 19.27 RCW and <br /> 296.200 WAC. <br /> � �� ._ J�.�.�� � ' L �Q G <br /> Signa ure ate <br /> i� <br /> �v�'�' �7 <br />