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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES 5_ S--0i <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />I263 Si uT>^e_ti UA411 CU 1 (-)A— . <br />PROJECT ADDRESS <br />Eve ' Wit/ U I <br />12)ggoy6jjg(o� 51F 200 4ep w 04Z5 CtA 9�y�3 <br />Owner Mail Address City State/Zip Phone <br />:de TU46 ^, ` Ce ,� r'/ 12i)3 un 3E suer c�71 Q���� 4y / 206 -71S-6070 <br />Tenant / /� Mail Address City Stale/Zip Phone <br />Tr. -J4' �',.l lCG/ 4&t' dou U <br />Electrical Contraclo Mail Address City Slate/Z0 Phone <br />70L <br />Slate License Number Contract Price of Work <br />Proposed Use of Building Contact Person (Plan Review) <br />Description of Work to Be Done: C` <br />2 yL/ Lr,fYeV� r/l,�.f.I <br />ell <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 �•3� <br />0S <br />1 hereby certify that I have read and examined this application and know the same to be true and <br />correct. All provisions of laws and ordinances governing this type of work will be completed <br />whether specified herein or not. The granting of a permit does not presume to give authority to <br />violate or cancel fhe previsions of any other state or local law regulating construction or the <br />a o performs f construction. That/ am authorized by the owner of this roperty to perform the <br />work for w It application is r ad"pd 1 comply with the State Contractors Law 16.27 RCW and <br />296.200 WA S` <br />5 � D <br />Signature Dat <br />�1, ti,.� v� �Gwe S �je✓� .-Ft .,.,w, bi' (-C.,l ��-�{� <br />