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� <br /> ELECTRICAL PERMI� APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES q �a q ,.d� <br /> 3200 CEDAR STREET, EVERETT, WA 98201 �.�p�09-1�(R <br /> 425-257-8810 - FAX 425-257-8857 —www.everetriva.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> �i�`� F�ve�rG��2e� �a�� . <br /> PROJECT ADDRESS ` ' <br /> Owner M;il Address Ciry Slate!Zip Phone <br /> ChPv1 L. �FSt. 51��i E��c���ti�eQ�� lil-� �v�.r� W� <br /> Tenant Mail Address City State/Zip Phone <br /> 1,���cLa Sv,�mS h'�e�1�. I`{t�U ���%(��IN�So. Se� �� ��,�1,3� �,� �j3�(� •��,, <br /> Electrical Contractor`- Mail Address City� Seate2ip Phone <br /> U t�.l 1, LS�� �� `� G� � � ��-�G � ?%U�. `� <br /> State License Number ' Contract Price of Work <br /> 1� �.S'��U V �v�� - <br /> Proposed Use of Building Contact Person (Plan Review) <br /> DescriptionofWorktoBeDone: �-11���1� �l.�i� `��CJ i�(Jr������,��V�a���' �I�eV�jl�V SI.OI�� <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 CO�E IS 3105 <br /> f here6y ceRity that I have read and examined this app�ication and know the same to be true and <br /> correct. All provisions of/aws and ordinances govemn._.;this t}�pe v(work will be completed <br /> �vhether specdied herein or not The granting o/a permd does not presume to give authonty to <br /> violate or cance/the provisions oI any other state or focal law regu/ating construcfion or the <br /> performance oI const�uction. Thaf 1 am authorized by the owner o/thrs propeRy fo perform the <br /> work for which application is made and I comply with the State Contractors Law 1 B.27 RCW and <br /> 296.200 WAC. <br /> �'�� �����C�cl,c. �l ' �`� � � `6 <br /> Signawre Date <br /> Eaa�cq-� �9 <br />