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� 5 -� � <br /> 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.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> .� i�'��� � � �>>/ <br /> ROJE'P C�SS , <br /> Owner tda�l Address City Slate!Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> �",��� �/ <br /> Eleclrical Conlractor Mail Address City Slate�Zip Phone <br /> Slale License Number Conlract Prico of Work <br /> Proposed Use of duilding Conlacl Person (Plan Review) <br /> Descriplion of Work lo Be Dona: l�l�_ .�T n.�.�� ��£1��� <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 CODE IS 3105 <br /> I hereby ceMily that I have read and examined tbis application and know the same to be true and <br /> correct. All provisions ollaws and ordinances govemmg fhis f}�pe o/work will be complefed <br /> whi her speci(ed herein or no[ The granfing o(a pennd does nof presume!o give authonty to <br /> violate or cancel the provisions olany ofher stafe or lor.al larv regu/ating conslruc6on or the <br /> peifom�ance o/constmcfion. That 1 am authonzed by Ihe owner ol this propeAy to pedomi fhe <br /> work for which applicafion is made and 1 compty with the Sfate Contractors La�v 18.27 RC W and <br /> 296.200 Ih�AC. <br /> � < ; U <br /> `- ` (,� �� 7/,3/G � �� �. <br /> � Signaturo Date ' <br />