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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857-www.evereriwa.org �� � /Z.r O�o <br /> APPLICATION5 ARE ACCEPTED FROM 8 AM TO 4 PM C' �6 I D �D76 <br /> ;r �,no NPu� ;-li- A✓e <br /> PROJECT ADDRESS <br /> Pc�e�5e�1 fi,�ec,�r;�s 237�� 79�-'` A.� � �� ��-I� wA�/9ezo5C4�,)5�(-� <br /> OWner Mail Address Cily S, telZip Phone <br /> �Il�Cl� I '��� ��rc��-` DI'Vz �ci�11�.5�.��� Y-rt�[�uXiV—['�ifN�:n., ��/ ��Zu� �1��9�� <br /> Tenanl Mail Address vc;ity SlatelZip Phone <br /> ��(� �/Y.�rTc �7d�X( lJilMlv� P� `Ji�v/r.��k.`r�� w��G��O � '],�3 <br /> Electrical CoM�acbr Mail Address Cily Sl elZip Phone <br /> /"J�cz>ir ,►� lyl(� 972 S L3 ��� , !�5D � <br /> Slate License Number Contr�e oi Work <br /> Proposed Use of Building Conlact Person (Plan Review) <br /> Descriplion of Work lo Dc Dono: <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 /> I heroby certily that I have read and exnmined this application and know Uie sarno fo be true and �� u lS�U-C�l lc <br /> correr,(. All provisions ollaws and orAinances govemmg this type o(work will be complefed <br /> whefher specified herein or not The gran(ing o(a pemuf does not presume fo give authonry fo <br /> violnte or cancel the provisions ol any other stafe or locol law regulating consfrucfion or fho <br /> perlominnce of constnrction. Thaf 1 am aufhonzed by fhe owner ollhis property to perfomi fhe <br /> �vork lor ivliich epplication is made and 1 compl}��+•ith the Stafe Contractors Law 18.27 RCW and <br /> 29G.200 WAC. <br /> �rl����m� <br /> Signature • Oata <br />