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� (" <br /> ELECTRICAL PERMIT APPLICATION <br /> �ITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857—www.everethva.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -DEBIT F�CREDIT CARDS ARE NOT ACCEPTED <br /> 11330 HWY 99 E�EQ.Err WA 48aoy <br /> PROJECT ADDRFSS <br /> Pu��- A - PA¢'r _ 11 33o uwti 99 E�ERErr e�+A 9flao�F��5��� '1 <br /> Owner Mail Address City State/Zip Phone <br /> �uu_. -A - PA2T 11 33D HWY RQ EvEQErr t�,a 992o�v[_sI'7�t3 - 3 4? <br /> Tenan! Maii Address Ciry ShatelLp f'none <br /> WN��fE 3Ecu2i•rrL I�iQ08 1-1w4 q9 WNNWOOn WA 94�03[c�'7 <br /> Electricel Contractor Mail Address City State/Zip Phone <br /> wH��S3o 4ySP � 4. o00 <br /> State Licen;e Number Contract Price of Work <br /> �FF�CE SR4C£. QRV ��1�TE ��++��fE 3Ec.uGtryJ <br /> Proposed Use of Building Cont�ct Person (Plan Review) <br /> Gescription of Work to Be Dene: i NSrA�.��a l� r.+nneRA3 N Q� 2 E� A.�D <br /> 2uNa�N , W�2E.5 fa2 .� furU2ES Fo2 cEL.+R_�Tv A�2poS� <br /> NOTE: WIRING IN fvQN-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAI'S, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 here6y ceRify that I have read and examined this application and know the same to be true and <br /> correct. All provisions of laws anr'ordinances goveming this type ol work will be completed <br /> whether specdied herein or not. fhe granfing of e oermd does not resume to givc authonty to <br /> violate or cancel the provisions of any other state or local law reguPating construction�r the <br /> peAormance of construction. Thaf I am authorized 6y the owner o/this proparty to perfoim the <br /> work/or which application is made and I comply with the Stafe Contractors Law 18.27 FtCW and <br /> 296.200 WAC. <br /> . w i . 1l `�` -7�/2�0 y <br /> Signature te <br /> � / <br /> � 7�7� <br />