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( <br />ELEC�RICAL PERMIT APPLIC�T'ON <br />CiTY OF EVERETT PERMIT SERVICES �q _�� <br />3200 CEDAR STREET, EVERETT, WA 98201 g �i I I <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.or Z—��riZ <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />� I 2� �VQ{�� r�i� ��,L� � I �O <br />PROJECT ADDRESS <br />�wner <br />Mail Address <br />City <br />Slate/Zip [y2� Phone <br />3$�'�lll� <br />,�� - , ...,.. .,. - -- - <br />Tenant Mail ' ess City Slate2ip � hane <br />� �r � �_ <br />�� C Cl �-��� 5�21�� 2l�Or��N� A��„ ,��y2.�3 _z�:�s_?12k: <br />Cil State/Zip Phone <br />Eleclrical Contractor Mail Address Y <br />�,� E���G � � G�� � � 70� � <br />Stale License Number Conlract Price of Work <br />/��I Ctv 1,� LL.� �� <br />� ��W ` Conlact Person (Plan Review) <br />Proposed Use of Building <br />Descriplion of Work lo Be Done: l j� �� I�"'""�- <� '^'" –�/ `� <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 3905 <br />I hereby cerfify thaf 1 have read and examined this application and know fhe same fo be frue and <br />correcL All provisions o/ /a ws and ordinances goveming fhis type o/ work will be compfeted <br />whefher specified herein or hoL The granting oI a permd does not resume to give authonly fo <br />violate or cancel the provisions ol any other stafe or local law reguPting construcfion or Ihe <br />performance o( consfrucfion. That I am authodzed by fhe owner o/ fhis property to pedorm the <br />work /or which application is made and 1 comply with Ihe Sfafe Contractors Law 18.27 RCW and <br />296.2UQ WAC. <br />�—�"'" � �}..1��� -- 1 �Z'� I � � <br />ignature �a� � <br />n r� <br />vU ( ��/\ �� Y K'L'� W' w v� .. <br />1 �('c /l. <br />FEE ` <br />50 �,_., <br />�E1112-I �eZ <br />