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ELECTRIGAL PERI`JIiT A,PPLICA�ION <br /> CITY OF EVERETT PE�CMiT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 IO'"� � � <br /> 425-257-8810 - FAX 425-257-8857 -www.everettwa.org ��81�-1,s3 <br /> APPLICA'�IONS ARE ACCEPTED FROM S AM TO 4 PM <br /> I C,�/�! l/c^�rJ ,/ l��z• ,��GT }� 3 ��Ve Rc ;r <br /> PROJECT ADDRESS <br /> `� f���E �OtvKJi/7,� �!'K�S� � <br /> Ownef Mail Addmss City State.2ip Phone <br /> Tenanl Mail Address Cily StatelZip Phone <br /> Cc�;��R-/ ��rctn�� l�C^ �c�� 1�2z �'�1n>svt//c W�! 9P'2>C �'izs�xto -i��a <br /> Electrical Coniraclor Mail Address City State/Zip Phone <br /> CG',��T U C_=� G��/!�2 <br /> Slale License Number ConUact Price of Work <br /> Propo d Use Of Building Contact Person (Plan Review) <br /> Description of Work to Be Done: �)C kl � S �' SQ �i l�C�M� � I <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE I� RACEWAYS, MC OR AC CABLE. <br /> I CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certily Ihaf 1 have read and examined this applicafion and know fhe sa�ie to be Irue and <br /> conecL All prov�sions of laws and ordinances goveming fiiis type oI work will be complefed <br /> whether spea6ed herein or noL The granfing ol a penmt does not resume fo give authonty to <br /> violate cr cancel fhe provisions olany otner sfafe or locallaw reguPating construchon or the <br /> pertormance o/construction. That I am authorized by Ihe owner of fhis property to pedorm the <br /> �vork lor�vhich applicafion is made and 1 comply with the State Contrac(ors Law 1827 RCW and <br /> 296.200 WAC. � <br /> � _ , ' <br /> � <br /> `-- �,��--�.:v_ --- _ �c�/�a 1��� <br /> �'SignaWre Dale <br /> r� � <br /> � ��� iS <br />