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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.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PROJECT ADDRESS <br />>l ����_3 'i/9r% /"�'JrkC,�`iif� /�/�:l-•� .�1� � ��:: <br />Owner Mail Address City Stale/Lip Phone <br />Tenant ,.y Mail Address City StateMp Phone <br />5 ♦>e.�1/ /121 4" //L. <br />Electrical Contractor Mail Address CRY State/Zip Phone <br />/fIelfmCi-e)77Qit/ <br />State License Number Contract Price of Work <br />Proposed Use of Building L Contact Person (Plan Review) <br />Description of Work to Be Done: ��! .d't ' G` !�,'7,J `� ��'//' � •% ''�• `' <br />41,E <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 7105 <br />1 hereby certify that 1 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 />whetter 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 slate or local law regulating construction or the <br />performance of construction. Thal I am authorized by the owner of this pmpedy to perform the <br />work for which application is made and I comply with the State ContractorsLaw 18 27 RCW and <br />296.200 WAC. / <br />;Z. j •/- <br />Signature Date <br />E 07U4 <br />: <br />