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� r <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 />Zoi ��JL�Qn t� Z C�C� <br />/PROJECT ADDRESS ,✓ /; <br />l Ui111111�JIh I I�iill 'J�Z-�1 Uj 0LUU t1b&Pf�-� talk igJO9 <br />t <br />Owner Mail dress City %— State2lp _Phone <br />J4o nq- <br />37o z. <br />Tenant Mail Address City State/Zip Phone <br />B-O l ljw3� Z4-16L_:kZ- <br />Electrical Contractor Mail Address City State/Zip 9 B W <J Phone )7 fr <br />1�1N)ner 39C1 I13c- I boo <br />State License Number Contract Price of Work <br />Proposed Use of Building Contact Person (Plan Review) <br />Description of Work to Be Done: 710 J I lat <br />cam t20er vcu n') <br />NOTE: WIRING It" NON -DWELLINGS IS REQUIRED TO FEE <br />BE IN RA SWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby certify that I have read and examined this application and know the same to be true and <br />correct. All provisions of laws and ordinances governing this type of work will be completed <br />whether specified herein or not. The granting of a permit does not resume to give authority to <br />violate or cancel the provisions of any other state or local law regulating construction or the <br />performance of construction. That 1 am authorized by the owner of this property to perform the <br />work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and <br />296.200 WA C. L% <br />LEA I�tu'itif �I �L' , <br />Signature Date <br />