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ri <br />FJ <br />ELECTkICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET EVEREI T, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />3vS SE E`4fVLgT- V41411 04( C(qA( W7rtC(_ `RRm) <br />PROJECT ADDRESS <br />JAvt,-i.�4 Zt(fcF CD nco nn Sr. Srfru IRAVUSCO , cA Y-1103 9K-so-1lBG <br />Ocmor Mall ltddmse City State/Zip I'honv <br />,J AV"3jA Z.5 5E Kycrra?-r PKA i (JA� i6yucrr! CALF 9?.05 <br />Ten.url Mail Address <br />Cifi Phone <br />._TOLL( ELF_ZYE� j-414 lt8(b /.(E If AV 5r•-OKlAyp LJA 3Y Yes -Sri 8rz4 <br />Electrical Contractor Mail Address City Stme/zip Phone <br />70(-95u38q-eLk_ t /y M— <br />Stale License Number Contract Price of Work <br />'KETA1L- 1�4kdi �uz-- <br />Proposed Use of Building GContactP'elrs11on (Plan Review) <br />Description of Work to Be Done: ( IL �kCJ-ag • k)D2lL J FZ gW 7-e',( Y41-7 <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 />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 goveming this typo of work will be completed µ �'S9• (/ <br />whether specified herein or not. Tire granting of a permit does not presume to give authority to <br />violate or cancel the previsions of any other state or local law regulating construction or the <br />m <br />perforance of construction. That 1 am authorized by the owner of this property to perform the l% <br />work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />Signature Date <br />