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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES -7 .-I Z -o L1 <br />3200 CEDAR STREET, EVERETT, WA 98201 gyp 407--031j <br />42E-257-8810 - FAX 425-257-8857 — vmrw.everettwa.orD <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />'T 71 :F._ t_ L c%_.j�CC <br />PROJECT ADDRESS <br />Owner Mail Address City StalelZip Phone <br />Tenant Mail Address City State/Zip Phone <br />1749 sr l ozfeeA Cot o kojE AD u,f W?-Cy (�q}s)Zio-� <br />Electrical Contractor Mail Address City State/Zip Phone <br />� ao <br />Q-kk�c g �4 .�� 1xo�. <br />State License Number Contract Price of Work <br />Proposed Use of Building Contact Person (Plan Review) <br />Description of Work to Be Done:�t/IT w ✓7=GF �%,T NOTE: WIRING WIRING IN NON -DWELLINGS IS REQUIRED TC 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 npplication and know the same to be true and <br />correct. All provisions of laws and ordinances governing this type of work will be completed <br />whether specified herein or not. The granting of a permit does not presume to give authority to <br />violate or cancel the provisions of any other state or local law regulating construction or the <br />performance of construction. That 1 am authorized by the owner of this roperty to perform the <br />work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />GL)Mo radQ art_ >-!z -C <br />Signature Date <br />>4 <br />