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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 96201 <br />423-257-8810 - FAX 425-257-8857 — www.eve:'eltwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />_ 30q sE CyX Q4+ IT , WW <br />PROJECT ADDRESS <br />Owner Mail Address City State/Zip/M)1 Phone <br />Tenant Mail Address C'ry State/Zip Phore <br />Vyl�(�e SeCter��4-t� SU�4ej')j9 1001 PalolminD IYt - Ric)-Pie(I q8L <br />Electrical Contractor it Add9va City Stalwzip l C DZ_O?�th <br />_ \�ylt 1T)-:239 DNS P 191500.E JlU <br />State License Number Contract Prise of Work <br />des ��arY► tan <br />Proposed Use of Building Contact Person (Plan Review) <br />g50OS9 <br />Square Footage (If residential new construction, remodel or addition) <br />Description of Work to Be Done: <br />n <br />n <br />NOTE: WIRING IN NON -DWELLINGS IS REQUIRED TO FEE <br />BE IN RACEWAYS, MC OR AC CABLE. So,D_6 <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 310S <br />I hereby cer* that I have mad and examined Ibis application and know (he same to be true and <br />correct. All provisions of laws and ordinances governing this type of work will be completed <br />whMer specified herein or not. The granting of a pemut does not pmsume to give authority to 7 <br />viol ate or cancel(he pmvisionsofany other state orlocal law regula(rngconstrucbonarlhe 50�� 33 <br />perfomrance of consduction. That I am authorized by the owner of this roperfy 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 AIC. <br />gnature ate <br />