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ELEGTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICE5 <br /> 3200 CEDAR STREET, EVERETT, WA 98201 � � � `� --� 5 <br /> 425-257��8810 - FAX 425-257-8857 —www.ev>�rettwa.org <br /> APPLICATIONS!�RE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> 1��� St' ���' eil/k�,�i I,��� <br /> PROJECT ADDRESS <br /> .—��-� – -- <br /> Owne� Mail Address City State/Zip Phone <br /> ✓' e�1�`S� � J����(rG�7�`. /UPJ�v���f'� ��" 7�� / U51 ��W <br /> Tenant Mail Address City St2te/Zio Phone <br /> L��ti�z��s <br /> Electrical Contractor Mail Address City StatelZip Phone <br /> (,(��J�L�ys�e��SMc«<�,,���. � �." <br /> ��� <br /> State License Num6er Contract Price of Work <br /> �tN=rc_s�9w SGzp 2� ��`� <br /> �o�a���g:.,n�.., ��6j� � <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Description of Work to Be Dr,ne: •��P �o��•i�,��c/P-� � f'k�`�/'�y� / 'i e��"'0�1'�7— <br /> NOT[: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. n/ <br /> �� <br /> CITY OF EVERE i7 LOCAL SALES TAX CODE IS 3105 <br /> (hereb}�certily that I have read and examined this application and know the same fo be true and <br /> correct. All provisions of laws and ordinances govemmg this type o!work will be completed <br /> �vhether specified herein or nnt. The granting of a permrt does net presume to give authonty to <br /> violate or cancel the provisions of�ny other state or local law regulatrng conshuc6on or the <br /> peAormance of consvuct�on. That I am authorized by the owner of this property to peAorm the <br /> work for which application is made and I cemply wifb the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. ^ i <br /> / \ � � <br /> I Signawre Date / (_l l/ <br /> ( ,V1� <br /> iV� <br /> � <br />