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EL�CTRICAL PERMIT APPLi�ATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 � —aS� <br /> 425-257-88 i 0 - FAX 425-257-8857—www.everettwa.org <br /> APpLICATIONS ARE ACCEPTED FPOM 8 AM TO4 PM G'06o ) vJ�� <br /> � �%/S <<�,�-� ,�� �, -� ,�� i <br /> PROJECT ADDRESS <br /> �� �= �'�� �'' /J24 r�1<<, .__ <br /> O�ner Mail Address City Stale/Zip Phone <br /> Tenant Mail Address City Stale/Zip Phone <br /> �J�Sc� ��c <�t, � � � Z7` cv/r- `.• 5>c� 35�s�y <br /> � /l �� � Cc�t'�ti <br /> Electrical Conlraclor Mail hddress City State2ip Phone <br /> 1� J f/ � � h'� C.';.L.z lJ ! _ L�G�c.c. <br /> Slale license Number ConVact Price o(Work <br /> � <br /> � ,'C.< cY- %'!I <br /> Proposed Use of Buildinc� Conlacl Person (Plan Review) <br /> Descriplion of Work lo Be Done: ��✓`�� ���- i:l'- X <br /> � <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALtS TAX CODE IS 3105 <br /> 1 hereby certily that!have read and examined this application and know Ihe same fo be true and <br /> correct. All provisic ns o(laws and ordinances governing this type ol:vork will6e compleled <br /> whefher specdied herein or not The granfinc�o/a pernut does not resunte to give authonty to <br /> violate or cancel the provisions o(any other state or local law reguPting consWctinn or the <br /> perlonnance ol construcfion. That 1 am authorized by Ihe owner ol fhis property fo per�omi the <br /> wo�k Ior�vhich application is made and I canply with fhe Sfate Contractors Law 18.27 RCW and <br /> 29G.200 WAC. � <br /> 1 <br /> , <br /> � \__" l. �t. --�'�i t'" / ��—�" � <br /> SignaWre ^� Da�e <br /> ��(�0( - I�Z <br />