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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 9,9201 <br /> 425-257-8810 - FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM -DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> � � z � G� 1 �>., A��. <br /> PROJECT ADDRESS <br /> VRRCiU M SUAIME(�VOL17 ��.�.�{ l,u� ��� /{VQ �E'r?E�� ���' Qg2(l� 1�� �S� S�� / <br /> Owner Mail Address City SWte21p Ph�ne <br /> Tenant Mail Address City SWte2ip Phone <br /> Qk�,��R <br /> Electncal ConVaclor Matl Address City State/71p Phone <br /> State License Number Contract Price of Work � <br /> S !-i��1 S-I-o R A r <br /> Proposeo Use of Bwldmg Conlact Person (Plan Review) <br /> Oescription of Work to Be Done: � �C� C'I'R I L k � / I 9 fl l S � �V 7-I C�S <br /> _GVF2hPAd 7KD.M HOUSe f0 SI) d <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN R,4CEWAYS, MC OR AC CABLE. <br /> J� � <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 31Q5 <br /> I hereby certily that i have read and examined this application and know the same to be true and <br /> correct. A/l provisions o//aws and ordinances goveming fh�s type ol work will be completed <br /> whether specified herein or not. 7he granting o/a permd does not presume to give airthonty to <br /> pe�orman eno%consPru�tion�Thaf I am tauthoraized by the�owner of th/s propeRy tto pe�rme(he <br /> work lor which application is made and I comply with the State Contractors Law 18.27 RCW end <br /> 296.200 WAC. <br /> ���, �ti1 ��,m � l- 3�- 05 <br /> Signature Date <br /> ��J`�� ��Z <br />