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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-251-8810 - FAX 425-257-8857 — www.e\ierettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />/f 16 AAlbroo/c 4c,< <br />PROJECT ADDRESS L <br />Ciii.)i,n_, (C.,.lf/GCTO`, <br />Owner Mail Address City Slate/Zip Phone <br />Tenant Mail Address City Stale0p Phone <br />3Gu <br />A96 rig �7/,/ , /a„ r;./i1�i� t = <br />Electrical Contractor Mail Address City State/Zip Phone <br />Slate License Number Contract Price of Work <br />Proposed Use of Building Contact Person (Plan Review) <br />Description of Work to Be Done: �P42 O/'I / SC'✓!ir (r i 71 _C1 _ 4r r"C C_. <br />NOTE: WIRING IN NON -DWELLINGS IS REQUIRED TO FEE <br />BE IN RACEWAYS, MC OR AC CABLE. i 2 <br />.S -f <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby certify that 1 have read and examined this application and 6now 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 resume to give authority to <br />violate or cancel the revisions 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 />work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />Signature Date <br />