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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 <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />$ I S E VCf"4 Mall too'u <br />PROJECT ADDRESS <br />SIISE EVCte_ 4-Mull (Darn F_Ver2j-f— WA- q ;ot, 912 ta33 37o0 <br />Owner Mail Address Cilfy State/Zip Phone <br />&(sclara Hormin(A 911 S - Eyu-c.4 Mull WAN fq&,,_ k IA)A 9 ?10K 9u-o3-37 0 <br />Tenant J Mail Address City J State/Zip Phone <br />Ql��}TSio�11,S�tyic<s I(<212BoFlt�l�-rve } wu#ra3�1 MIICreek i,i¢ �SGI2 425-330-b1 <br />Electrical Contractor Mail Address City State/Zip Phone <br />State License Number Contract Price of Work <br />Rf- (ki� FrAA)Gonzalo _ <br />Proposed Use of Building Contact Person (Plan Review) <br />Description of Work to Be Done: LrLq It R 0_ka nj)tj 1? � tG� �q S - <br />r <br />_ I <br />NO1 E: 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 file same to be true and <br />correct. All provisions of laws and ordinances governing this type of work will be completed <br />whether spacr(ed herein or not. The granting of a permit does not resume to give authority to <br />violate or cancel the provisions of any other state or local law regulating construction or the <br />perforrnance of construction. That 1 am authorized by the owner of 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 WAC. <br />LR ald�0(o <br />Signature Date <br />Eor�02-rj; "1 <br />