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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERM11' SERVICES <br /> 3200 CEDAR STREET, EVERETf, WA 98201 <br /> 425-257-E810 - FAX425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> z2o i �o � ��� ��E <br /> PROJECT ADDRESS <br /> 3�0 -�}35-0�{86 <br /> �F��Ea PE6GY E+a�r��ocK, lSio STA�wooP-BRY�1- RD, �Run�G-rprJ w/.� <br /> Owner Mail Address Ciry StatelZip Phone <br /> `{ Z-S -ZS�--6 3 5"1 <br /> KE+J CRv ��.l , 2zoi � ,u �nr�n a�c- EuERE'tr wA qs2ur <br /> Tenant F.tail Flddiess city stalelzip Fhone <br /> ElectriCal CoMracto� Idail Address Cily StateiZip Phone <br /> State License Number Contract Price of Work <br /> �i��(..�c �AN/c Y 7C�< n •�vc `- <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Desaiption of Work to Be Done: C�iJir y ��i✓ ' o l�n � r � — �o ri �%,vr' St� ✓• � •' <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 he�eby ceRi(y thaf I have read mid examined this application and know the sarne to 6e true and <br /> conect All provisions ollaws and ordinances govemmg fhis rype o(work will be comple(ed <br /> whefher specilied lierern or noL The granting o(a pemut does not resume to give aufhonty lo <br /> v�olrite or cancel the provisions of any ofher stafe or/ocal law reguPating wnstructron or the <br /> perlonnance of construchon. That 1 am authonzed by lhe owner ol this property fo perlorm fhe <br /> work Ior which applicafion is made and I comply with the State Cont�acrors law 78.27 RCW and <br /> 296.200 WAC. <br /> ///,� ' �� �' ' <br /> �" "C �i� � • ���`� 5�7 �'7 <br /> " SignaWre Date �� <br /> /i� <br /> ��`� <br />