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T <br />ELECTRICAL PEI�MIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-2F?-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />q�3o ��ER�2c-c.v wAY -- <br />PROJECT ADDRESS <br />Owner <br />Mail Adtlress <br />City <br />Stale/Zip <br />C� �-�---D �p <br />cyo6o6-al� <br />Phone <br />�1fHitiGTDu STfiTE fEG�rEf <br />Tenant Mail Address Cily Stale/Zio Phone <br />u��T[:� SrsieMS� i.vc. 925 N� �3o�'�"i2 SE�trGE uA ysr33 2o�-vyz-9�f�� <br />Eleclrical Conlractor Mail Address Cily Slate/Zip Phone <br />State License Number <br />Proposed Use o( Building <br />Description of Work lo Be Done: l�S'ft.� � � r"`�"`u S� <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 />� ��obv <br />ConUect Price of Work <br />Contacl Person (Plan Revie�v) <br />1 hereby certily that 1 have read �nd examined llns application and kno�v the same to be Uue and <br />conect. All piov�sions o(laws and ordinances goveming this type ol �vork will be cornpleted <br />whefher spea6ed herein or noL The granting oI a pernuf does not resume to r�ive authonty to <br />violafe or cancel the provisions oI any other state or local law re�uPtin� construcfion or Ihe <br />per/ermance ol consfrucfion. That 1 am authorized by ihe owner o( this property fo peAorm tiie <br />work /or which applicafion is made and 1 cornply �rifh fhe State Coniractors La�v 18.27 RCW and <br />296.200 WAC. <br />Z �✓N L= 20 <br />F[E <br />� �(a0(�-0l �f <br />