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� <br /> ELFCTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES �_ aa--n � <br /> 3200 CEDAR STREET, EVERETT, WA 98201 CO ��7��� <br /> 425-257-8810 - FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARF_ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CR=DIT CARDS ARE NOT ACCEPTED <br /> l d[�0 �<2 9��3'U� /'T vli <br /> PROJECT ADDRESS <br /> '' n,�;� (/J�� �a B�x /�z �,tul�r(�� 1�(/'� �e'�7�' <br /> �er ail Addre�s Cily State/Zip Phone <br /> Lz5' � 3s9-i <br /> Tenanl Mail Address Ci:y Stale2ip Phone <br /> Eleclrical Contractor Mail Address City Slate/Zip Phone <br /> Slate License Number Contract Price o(Work <br /> Proposed Use of Building C�ntact Person (P�an Review) <br /> � <br /> Descriplion af Work to Be Done: ��^IP �'��YP�"� � <br /> I <br /> NO"fE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> r,ITY OF EVERETT LOGAL SALES TAX CODE IS 3105 <br /> I hereUy certily�hat I have read and examined this application and kno�v fhe same fo be true and �\�G� �J � <br /> correct. All prowsions ol laws and ordinances govern�ng fhis type ol work�vili be completed � �C <br /> whether speci6ed herein or not The granting o!a permd does not presimie to give aulhonty to ��U <br /> violafe or r,� 1 fhe provisions o(any other state or local law regulafing consfruchon or the <br /> perlorm Ace o construction. Thaf 1 am authorized by fhe owner o/fh�s property to per/orm the <br /> work r �rhic applicafi is m de and I comply with the Sfafe Contractors Law 18.27 RCW and <br /> Zse.z o�g � <br /> . <br /> _�� �� '�,f� �•12 t' <br /> � Signature Date <br />