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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — wv✓w.eve,. ettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />1yDZ Stl 114WL "y <br />PROJECT ADDRESS <br />Owner Mail Address City State/Zip Phone <br />ID I�-1 <br />Tenant Mail Address City State/Zip Phone <br />MF�NAA/IcAi: %30153`' 4ve Nrr �edy,,,,ud L(t-, y805Z (gZ5)803-9 <br />Electrical Contractor Mail Address City Stale/Zip Phone <br />MQ1T/V195iNS <br />State License Number Contract Price of Work <br />Proposed Use of Building Contact Person (Plan Review) <br />Description of Work to Be Dona: <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 />I hereby certify that 1 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 the provisions of any other state or local law regulating construction or the <br />performance of construction. That I am authorized by the owner or this property to perform the <br />work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br />296.200 WACL <br />ef Z__ <br />Si ature Uale <br />?y <br />