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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 -3 O9 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />(y—OSD 3-10� <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />LIN SE E✓ERE rr MAC S IO W 15-7 <br />PROJECTADDRESS <br />Owner Mail Address City State0p Phone <br />�uC o2! A751) /4102 SE CVZ;g97 /%411. 91/89E77 WA <br />Tenant Mail Address City State2ip Phone <br />�gJFrc FRe 1S�eu2t �nlc. gl-? PDPLAk PLACES r Si- TILE U/A )�is<Si %2D6�7e8-3?61 <br />Electrical Contractor Mail Address City State/Zip Phone <br />PA01ZF S973 PIA $ 200= <br />State License Number Contract Price of Work <br />Proposed Use of Building Contact Person (Plan Revievi) <br />Description of Work to Be Done: <br />T1 A tn/ V00-A-C-� ' -FIVSTALL /t/F�('(';/g ynisr / rDi✓/ Ta.C/ri6- <br />C-0W iPM E/'iT Io-A #- og - 6651 <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 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 goveming this type of work tvill be completed <br />whether specified herein or not. The granting of a permit does not presume 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 />295.200 WAC. ?� % <br />/' 3 3 0 <br />Signature Date <br />