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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEGAR 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 />�'�S �r�N� rqvc, <br />PROJECT ADDRESS <br />c�L, 'L1 1 <br />�L�q�Nnli� ��- i 7_ C�C'i� 3Gob ��1�;S�a� ;r-�c�-E �:� MA�.�j�.l�P <br />Owner MailAddress • Gty Stale2ip i. Phone <br />;,. C 4� 5 � " �1 2 `) <br />l <br />Tenanl <br />Mail Address <br />City <br />Stale/Zip <br />Phone <br />� � yZS- 3�y-s3 S3 <br />���Yi'ils Ci�l S i Co �i`� Z� l G9 Av,� Sr_ S�;,l�•��5�, 4�.'fi `18L9� <br />Electrical ConUaclor A1ail Address City Stafe2ip Phone <br />Stale License Number <br />_ _� 5,..�G- Lc <br />Desr.ription of \Vork �o �c Don�:: <br />NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO <br />BE IN RACEWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CG ' IS 3105 <br />: / ., �'' _ � 'L � 0=J <br />��� � <br />Conlract Price of Work <br />Contact Person (Plan Review) <br />I hereby certi/y fhat I have read and examined this applicafion and know the same fo be tr�e and <br />correcL All prowsions o/ la�vs and ordinancas govenung this type al work will be completed <br />�vhether specined hcrcin or not The g�anting ol a pi°nnrt does nof resume to give authority to <br />violate or cancel the provi�ions of any other state or Ucnl !aw rogu�fing consWcfion or fhe <br />perfomiance o/ conslructi . That I am authonzed 6} the o�rner o/ this property fo peAomi the <br />,rork for �rhich application i made and I compl}� �tiith Ine Sfafe Confractors Law 18.27 RCW and <br />:9G.200 WAC. <br />_ __--- ---- �[o�/ � � Z�v� <br />�M,.��„-.ol o,�e <br />FEE <br />.i , <br />��cS� l I - U � <br />