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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 — www.everettwa.org C /D a 01� <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PROJECT ADDRESS <br />Owner Mail Address City Stale/Zip Phone <br />V Nam; /s 3vs Sc= c l�i� /i 4l<y 2 6 E�c�el �✓4 <br />Tenant Mail Address City State/Zip Phone <br />� 0,,,14cr cl<<l„e i3 ?ys hP�/ 13ot4, L44. 9923z <br />Electrical Contractor Mall Address City StaleOp Phone <br />c� ,no 75-7 <br />1001f. �r0V �'�� <br />State License Number Contract Price of Work <br />/o �/ y2 s ass 32 y3 <br />Proposed Use of Building Contact Person (Plan Review) <br />Description of Work to Be Done: �✓r� �Cw c r c v l�f �+� 4 <br />NOTE: WIRING IN NON -DWELLINGS IS REQUIRED TO FEE <br />BE IN RACEWAYS, MC OR AC CABLE. �) <br />/Lp. Q <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby certify that I have read and examined this applicatton and know the some to be true and <br />corrr.ct. All provisions of laws and ordinances governing this type of work will be completed <br />whother specified herein or not. The granting of a permit does not presume to give authority to <br />violate or cancel the pprovisions of any other state or local law regulating construction or the <br />p erformance of construction. That I am authorized by the owner of this property to perform the s� n <br />work for which applicaticn Is made and I comply with the State Contractors Law 18.27 RCN and <br />20.200 WAC� / <br />Signature Dale <br />