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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 5— I 7�d � <br /> 425-257-8810 - FAi(425-257-8857—www.everetlwa.org CO'�OS—/%-�j <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> I� `�-l I-�o y T <br /> PROJECT ADDRESS <br /> �%G1 l�� i�'L <br /> IOwnef Mail Address City Stale2ip Phone <br /> Tenanl Mail Address Cily Stale2ip Phone <br /> c�JMM « ���-�T��L 62��3 Z61S}ST Al� �'f�A��1wo�D w/a �7i'li <br /> EleclricalConlractor MailAddress Gty Statc/Zip Phone <br /> `�,�r�r�IC � 4�o�ti <br /> Slate License Number Conlract Price of Work <br /> �Q�EX <br /> Proposed Use ol Building Conlact Person (Plan Review) <br /> Descriplion<'W ork lo�c Donc: �J I�{. N�v.� ��l-�p�h L-UO �11'n1" ��T"'lllL� <br /> �:OTE� WIRING IN NON-DWELLINGS �S REQUIRED TO FEE <br /> BE IN RACEWAYS,MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby certi(y fhaf I l�ave read nnd examined fliis application and know fhe same fo bo truo and <br /> correct. AIf provisions ollaws nnd ordinances c�oveming fhls type ol work will be cornpleted <br /> whefher specified herein or not. 7he granting o/a pennrt does nof resume fo give aufhonty fo <br /> violate or cencel the provisions o�any oCier sfale or locul law reguPfing consfrucfion or the <br /> peAonnance o/construclion. Thef I am authonzod by fhe o�sner o/Ihis prcpedy fo pedomi the <br /> work Ior whir.h applicafion is made and 1 compty wifh fhe Sfate Confraclors Law 18.27 RC W snd .— <br /> 296.200 WAC. / � <br /> � _ � � � <br /> ,r �-`— S-1� �O � �Ci _� <br /> SignaWre Data <br />