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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 <br />42.ILA F:�dral Aye <br />PRROJECT ADDRESS <br />-P, 4.P ri n u Y 21 Y Aue <br />EVfne 7i��- ' R 203 <br />Owner Mail Address City <br />Slate/Zip Phone <br />4 25 789 i�os <br />Tenant Mail Address City <br />State/Zip Phone <br />OU)r) Qr <br />Electrical Contractor Mail Address City <br />S(ate/Zip Phone <br />oU-) V1 e r <br />Owlmr <br />State License Number Contract <br />Price of Work <br />e <br />Proposed Use of Building contact <br />Persor (Plan Review)� <br />/ <br />UPG e X[S / ! r 7G /h Q �PG� <br />/ <br />[C�4 "( l/5f er✓7 <br />Description of work to Be Done: v-ac P <br />Ci✓tCA t11e•0 �e (_ec+Pllcn_ l 45" llvfriode/ <br />NOTE: WIRING IN NON -DWELLINGS IS REQUIRED TO <br />BE IN RACEWAYS, MC OR AC CABLE. <br />FEE <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify that I have read and examined this application and know the same to be true and <br />be <br />correct. All provisions of laws and ordinances governing this type of work will completed <br />whether specified herein or not. The granting of a permit does not presume to give authority to <br />or local law regulating construction or the <br />violate or cancel the provisions of any other state <br />performance of construction. That I am authorized by the owner of this property to perform the <br />work to ppli on made and I canply with, the State Contractors Law 18.27 RCW and <br />298 0 WAC. <br />9gnature Dale <br />67 <br />go <br />