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( —� <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857—vvww.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> �ooa6 D�, k,�, wuy <br /> PROJECT ADDRESS <br /> " Gc,rc� Qeawl � � ozG Dc.lco�u wo. E�erri� wl� 9Bzo � <br /> Ownef Mail Address Ity StateZp Phone <br /> Tenant Mall Address City SfaleZp Phone <br /> ffl.L E�tc�r;C �c;f� 2352 y,� 193�� S� 5�orc����e W/� '$/33 (zub)365-65'H�/ <br /> EIecU:ca�Contractor Mail Address C�ty StateZp Phone <br /> A�cczc�cyg6Da � "a3 ' o � ,�roo <br /> State License Number ConVact Price of Wark <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Description of Work to Be Done: 1���'� �«w+p ��� �r eo i�+e� .��... � <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby certi/y that I have read and examined this app/ication and know the same to be true and <br /> cormct. All provisions of laws and ordinances governing th�s type o/work will be completed <br /> whether spec�(ed herein or not. The granting of a permd does not presume to give authority to <br /> violate or cancel the provisions of any other stafe or local law regWating consfructlon or fhe <br /> performance o/construchon. That I am authorized by the owner of this property to peAo�m the <br /> work(or which application is made and I comply with the State Cont2ctors Law 18.27 RC W and <br /> 296.200 WAC. <br /> ,�1�,�,�„ lL� r��/ 9� �o H <br /> SignaNre — )� <br /> �c� ' ' �� 7 <br />