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( i <br /> 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 - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> � IoZC� G2+�n� AVe, Eve,•��F� wfi <br /> PROJECT ADDRESS <br /> �/r+le��e �rsev II �r c�r,, �� q�e E�ere++- � d 98�� �ts asa-�3�3 <br /> Owne� Mail Address Ciry State/Zlp Phone <br /> Tenant Mail Address City State/7Jp Phone <br /> �-lere � G,9;re. T�u� ait� 130'" ,�� tir La�c Si-e✓e.,s� wn. QSds� Sl�ts-33s-I`1o7 <br /> Electncal Contractor Mail Address City SfateZp phone <br /> Nerea�% J8'o2KL �I ��I ��^ �-],$o ,a`� <br /> State �cense Number ConVact Prica of Work <br /> S t=�� <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Description of Work to Be Done: -�;x kno6 -�. - +�be S.DCceS ,h 645rMC.,�� ('¢ -µi-1h�L� <br /> pOX�S 1�r��.n1�5 ImS�i S�w.�l� W�re.._ �lVa �ll�N4 looS�� ��r. doatii�e �wPvc� <br /> (';rcu;4s '�� .Pa�,e.l <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 hereby certi(y that 1 have read and examined this application and know the same to be true and <br /> correct. All provisions ollaws and ordinances governing this type o1 work will be completed <br /> whether specified herein or not. 7'he granting o/a permit does notp resume to give authority to <br /> violate or cancel the provisions of any other state or local law regulating conshuchon or the <br /> perfo�mance o(construcbon. 7hat/am authc.ized by the owner o/this property to peAorm the <br /> work!o�which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 2°6.200 WAC. <br /> 11 ��� � <br /> ��' " ,. ? //- '.�dZlil�� �-3c�-t7� <br /> Signature �ate <br /> J���'13 J <br /> V <br />