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� <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES �_1�-►� <br />3200 CEDAR STREET, EVERETT, WA 98201 E����_�t�( <br />425-257-8810 - FAX 425-257-8857 - www.evereltwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />15 �� 5 r �vE� J=� �¢�L wy <br />PROJECT ADDRESS <br />�� �'mµ�C � <br />Owner <br />Tenant <br />Ma�l Address <br />Eleclrical Conlreclor Mali Address <br />Y�,��,I .�� �� � ��2 <br />Slate L'icense Number ' <br />/1/'/-�-1 �- S fio�% <br />Prop sed se of Building <br />Descriplion of Work lo Bo Done: <br />Clty <br />WX City <br />'� S� <br />City <br />� �rof/,a� -�L:�q�t� � <br />. <br />NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO <br />BE IN RACEWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />State/Zlp <br />Slate2ip <br />Slale2ip <br />�S a O <br />Contract Price o( Work <br />Phone <br />Phone <br />253 �l� <br />Phone <br />Contact Person (Plan Review) <br />1 hereby cerfify thaf 1 fiave read and examined this applicafion and know the same to 6e frue and <br />correct. All provlslons o( laws and ordinances goveming this type o( woric will be complefed <br />whefher specified herein or not. The granfing of a permit does not presume to glve authority to <br />violafe or cancel the provisions o/ any ofher stafe or local law regulafing construction or the <br />perlormance of consfruction. That 1 am aufhorized by fhe owner of thls property to perform the <br />work Ior wh7ch applicaflon !s made and 1 comply with fhe State Contrac(ors Law 18.27 RCW and <br />296.200 WAC. <br />����"`��__ � � ll � l I <br />Signalure Date <br />FEE <br />/�7 s� <br />�/D/-D�l <br />