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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 /> S�"j�1 ['orMnt.t/��(✓i-L .AC�� y� � <br /> PROJECT ADDRESS 3S3 <br /> 51�`G 'L <br /> U,�.u�l .1��:.Lz�1}.sc,rn� F. ,� �) �for'� ��,,��k.,ex�,.� f�t! Yd',zc� <br /> Owner Mail Address Cily Slale2ip ?hone <br /> Tenant A1ail Address City State/Zip Phone <br /> �1ni S�2 S <br /> �E��h,t„�`k. s�.�1L•nl � Fb;�vi�,e � �01 �v �4v /cW �; '�SP �.�� <br /> Electncal ConlraCtor Atail Address Ciry State2ip Phone <br /> F; �nnrss/ya c.N <br /> State License Number Conlract Price of Work <br /> .�'F/L <br /> Proposed Use of Building Contacl Person (Plan Review) <br /> Description of Work to Be Dono: ��n�jh. I�i L��/VT'" .iJ.��j I�GI ���C `��C CV /1'1(^r/E�� , <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS. MC OR AC CABLE. �5 on <br /> � <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 here6y cerfily tf•at I have read and examined fhis application and know fhe same fo be frue and <br /> correct. All provisions o(laws and ordinances govemmg fhis fype of work will be completed <br /> whether specified herein or noL 7he granling o�a pemut does not presume to give authonty to <br /> violate or cancel fhe �rovisions ot any ofher sfate or local law regu/ating cauWcfion or ihe <br /> perfomiance ol cons��uc(ion. That I am aufhorrzed by fhe owner o/fh�s properly fo perlortn the <br /> u�ork/or�vhich application is made and I comply�rith the Sfate Con;raclors Law 18.27 RCW and <br /> 296.200 WAC. <br /> ,!y� �1,�/�-� � //� /��, <br /> / SignaWre Date <br /> f <br /> �oC�GI-D�'� <br />