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FroR:OutToday 4258G91071 07/14�2D11 11 :39 �391 P.002/002 <br /> I <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 —www.everettwa.org �,�I��„�� <br /> I APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �///���D6� <br /> ! (/ <br /> 4�15'J �Irx� �1- <br /> PROJECT ADDRESS <br /> �v�c:��+-r� n�ca�� HG�,�, e�m st .e��e�1- �wa, Geao3 <br /> Owne' MailAddress Clty StatelZip /��� Phone <br /> � Q 31 • 19 �`�- <br /> Tenanl MailAddress City State2ip Phcne <br /> r�c-� a s�,r�ric�s ac1�.CLl �� avc, �n�, c,�o� �-�ea�vvice GuGL Q&'��5 <br /> Electrical Contra r Mali Address City State2lp Phone <br /> s�� � c9e��- ec�a <br /> Cw��*� �, vz� �a,oov <br /> State License Number Contracl Price ot Work <br /> IC f'S\f�.lA1�lA�-/ CT`A(M'1(�� <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Description of Work to Be Done: ,x(�.nl U l.0 C� GO D1M'1(� \Y ti I\� F� )�J��� <br /> 1�►'�tS <br /> NOTE: WIRING IN NON-DWELLINGS IS RE�UIRED TO FEE <br /> 6[ IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certi/y fhef I have read and examined lhis npplicafion and know!he same to be fiue and <br /> carrect. All provisions oflaws and ordinancos goveming this type o(work will be completed <br /> whether specified hercin or not. Tho gran(ing ol a perm�t does nof msumo fo give authonty fo <br /> violafe orcancel tho provisions o/any otf�erstafe orlocal law reguPting consfnrclion or the <br /> perfom�anca o/construcfion. Thnt I em aufhorized by the owner of Ihw property to peAomt(he <br /> work/or which application is made and 1 comply�vilh tho State Confnc(ors Law 18.27 RCW ond � <br /> 29E.200 WFlC. <br /> ; <br /> ���w� � � �� �� � 6 <br /> I Signa a e <br />