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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 ct j 2/ D CC 5 <br />PROJECT ADDRESS <br />5Te,+&T'r,.;rEutsj%-►JALLC 19too Vam1n gMtuhsu,4o5"" <br />Owner Mail Address City State/Zip Phone <br />Tenant Mail Address City State/Zip Phone <br />Vuuu.�W� (T&-�3 X6-y2 q-13-Z <br />Electrical Conti cloy Mail Address City StalelZip Phone <br />3wMC) <br />Slate License Num¢er Contract Price of Work <br />Re y ie)m UY'^r_� <br />Proposed Use of Building Contact Person (Plan Review) <br />Square Footage (If residential new construction, remodel or addition) <br />Description of Work to Be Dane: k\ 4,%jK 2 -1!�re Frtj,.,,7r wA SlqtAs <br />NOTE: WIRING IN NON -DWELLINGS IS REQUIRED TO FEE BE IN RACEWAYS, MC OR AC CABLE. 00 <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby cerlify that I have read and examined this application and know the same to be true and /1OQ C <br />correct. All provisions of laws and ordinances governing this type of work will be completed Z (0_ ` J <br />whether specified herein or not. The granting of a permit does nol 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 I comply will) the State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />Signature Dale <br />