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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 V <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org &O 8C3 `1I O <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PROJECT ADDRESS <br />iv�� <br />Owner Mail Address City SlalefZip Phone <br />lit /J�f' / 9 3361 <br />tenant Mall Address City Stale/Zip Phone <br />fkL ' ///—DO&%,4,L /{t/E f! /E Lr%/ �J� cG' l zSZ /70� <br />Electrical Contractor Mail Address City State/Zip Phone <br />Slate License Number Contract Price of Work <br />P od Use of guilding Contact Person (Plan Review) <br />Description of Work to Be Done: <br />( ��-1 (L . '(Cd •��it C: f t?"'rli�..0 `< � �•t' � � - c-�`'"" GC.i <br />NOTE: WIRING IN NON -DWELLINGS IS REQUIRED TO FEE <br />BE IN RACEWAYS, MC OR AC CABLE O G <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby certify that I 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 />whether specified herein or not The granting of a permit does not presumo to give aufhonly to <br />violate or cancel the Provisions of any other state or local law regulating construction or the <br />performance of construction. That lam authorized by the owner of this roperty to perfonn the <br />work for whi pplicafion is made and I comply with the State Contractors Law 18.27 RC W and <br />296.200 W Xt- <br />� <br />SignalI Dale <br />