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ELECTRICAL PERMIT APPLICA,TION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-6857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> 1 ?i3 .�NOIV�'fV�/ ��'rYP� <br /> PROJECT ADDRESS <br /> (�)vd8-o,3S <br /> �a�wa�i-o�i �ev�I��nneMt �1�. I,LC I(QN� ;�vf�.�e:ex+v,r �[wv . 4�if�- .rDi� <br /> Owner T Mail Atltlres� Cily L-S-tatelZip „ Phone <br /> .7�'�4������T q���� <br /> �la�e,ri�l� <br /> Tenant Mail Address City Slafe/Zip Phone <br /> U(n�ve.d�a� .�tatn�ca� �6q01 LJ�IIra,�is �f �n�w�o�nc� . GJA �1�'6f�i �4?ll�-q <br /> Electrical Contractor Mail Atldmss Cily Ste!elZip � <br /> S1n1�t/EMSo��-II�Q � !. Z�J,oD <br /> State License Number Conlract Price of Work <br /> o�'-«_e_�c,�av�e��_ �a� M�l�.r <br /> Proposed Use f Buitding Contact Person (Plan Review) <br /> Description of Work to Be Done: l�jW VD�TUOK�._ t'1UF+ �- �'DLt�J79� (wI1V'1 IAA. <br /> NOTE: WIRING IN NON-UWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> i <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby certify fhat I have read and examined(his app!icafion and kno�v fhe same fo be true and <br /> correcf All provisions of laws and ordinances gov�mmg this type of�vork�vill 6e comp'2fed <br /> whether specified herein or not. The granting o/a permrt does not resume fo give au(honty lo <br /> violafe or cancel the provisions c(any o(her state or local la�v reguPfing construction or lha <br /> peAormance ol construction. Thaf 1 am authorrzed by the o�vner o(this property to per/orm the <br /> work/or which applica(ion is made and 1 comply with the Stafe Contractors Law 78.27 RCW and <br /> 296 200 WAC. <br /> ��� �����i M� i <br /> Ni L'A DSf�/� <br /> SignaNm Date � � `� <br /> i' <br /> =USvS -C-q`' <br />