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ELECTRICAL PERMIT APPLIIC:ATION <br />Cil-Y OF EVERETT PERMIT SERVICES <br />3200 CELLAR STREET, EVERE FT, WA 98201 <br />425-257-8810 - FAX 425-257-8857-- =Ni. eve rettwa.org p <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PROJECT ADDRESS <br />u1sT �r L�u814,46-rdffie112 <br />Owner Mail Address City Stale/Zip Phone <br />_i <br />Tenant Mall Address City State/Zip Phone <br />T o irl�>'!c� Nr • 77C), f _yhVe Pg 66V�� Jll GJ�C Od lo('f �� -091� <br />Electrical Contractor Mail Address City Statelzip Phone <br />TL'/'�)E'51 q 63 DZ A60 <br />State License Number Contract P ice of Wirk <br />l - A""a Ads) � rmA�- <br />Proposed Use of Building Contact Person (Plan Review) <br />Description of Work to Be Done: [Tl i'` of )D rL)iT I/Ir l A—LI l?S) Aawlir, <br />NOTE: WIRING IN NON -DWELLINGS IS REQUIRED TO FEE <br />BE IN RACEWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 he. eby certify that I have read and examined this application 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 I am authorized by the owner of this property to perform the <br />wont for which application is made and 1 comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />✓yam.. !.�`� <br />Signature Dale <br />