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�LECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT pERMIT SERVICES <br /> 3200 CED!•,R STREET, EVERETT, WA 98201 /p —.�� .�.�� <br /> 425-257-8810 - FAX 425-257-8857—www.everettwa.org �///D ��� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> 2�3 � 9 �d/vl l�q��/ 1� <br /> PROJ ECT ADDRESS <br /> L H �l� �P/1 ed��'� �3�9 ��.M �C,,� f� F,,�/�C`� �-�`� <br /> 0 er Mail Address City Staterzip Phone <br /> Tenanl �� Mail Address City Stale/Zip Phone <br /> f��No�e�lec+�,� I04Z1' �� ��1'r_ �l�e.J�v� G/�9 �d'Z� (4v' t���6/� <br /> Electrical Contractor Mail Address Ciry State2ip Phone <br /> I�Ho��s �sz4 � _ �'OG <br /> State Licensa Number Contract Price of Work <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Descripflon of Work to f3o Done: ��l/✓� re � GUJ� �"� '� "���• <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC ORAC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby certity fhat 1 have resd and examined this application and know the same to be frue and <br /> correct. All provisions of laws and crdinances goveming this type of work will be completeo <br /> whether specified hereln or noL The granting o/a pormd does not�resume to give authonty to <br /> violate or cancel the provisions of any other state or local law reg�leting consfruction or the <br /> performance of construction. That 1 am authorized 6y the owner of fhis�roperty fo perform the <br /> work for which application is made and 1 comply wifh the Sfafe Centractors Law 18.27 RCW and <br /> 296.200 WAC. �' I O , Q� <br /> `--�-- l0/Iz� I i <br /> SignaWre Date <br />