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� <br /> � gr3 � <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 /> l �/�— �— �r� r�c� ,4--v�� <br /> PROJECT ADDRESS � <br /> C ii V7 S /-4�4l�YI S �Q l�1r�.� �v (,l�/-� �R��d / <br /> Owner Mail Address Ciry State/up Phone <br /> � /� � <br /> Tenant Mail Address � . State2ip Phone <br /> �Q.�r.�,-�T E� �'� ymn � s�,.�,�(� �-ere�t l,vQ 9x-�,� u1S 7S�'f-6n7 <br /> Electrical Contractor Mail Address City State2ip Phone <br /> ����-{cr�1D�9�N <br /> State License Numher Contract Pnce of Work <br /> Il2p s� ��..v �e <br /> Proposed Use of Building Contact Parson (Plan Review) <br /> Description of Work to Be Done: /{�p�GV �9 a � �-Y`V/!� D�c GY �O t��� <br /> ,(��P UJ!Cn° <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SAIES TA.Y CODE IS J105 <br /> I here6y ceRify tnat I have read and exammed this applicatien and kno�.v the same to be true and <br /> '� correct. AU provisions o/laws and ordinances govemmg this rype cl�vcrk�vill be completed <br /> whether 5pecilied herein or neL The granting ol a pe�md does not presume to give authority to <br /> violate or cancel fhe provisions ol any other state crlocal law regulaUng construction or the <br /> ipedormance o(cens(ruUion. That I am authonzed by the owner of ihis property fo perform the <br /> �vork(or which application�s made and I compty with the State ConVac;ors Law 78.27 RCW and <br /> I 296.200 WAC. <br /> ��-�0��.�, �- 2r a� <br /> Signature Dare <br /> ���� /2� <br />