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, r <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 <br />/-I2 ("1aitctSOl� <br />PROJECT ADDRESS <br />C rr V 7.121 rtarliYt C�ece%t I�1 H2S 31�-�0 <br />Owner----rr'' Mail Address ON State/Zip Phone <br />Tenant Mail Address City State2lp Phone <br />go23 1_>oitlA-,)e S1 Src6ryo_\�, tt 1, C:i-2 i0 L125-3�J <br />leelrical Contractor Mail Address City State/Zip Phone <br />--:;>,E-9S1? 7 <br />Statd License Number Contract Price of Work <br />C1 + <br />Proposed Use of Building I Contact Person (Plan Review) <br />Description of Work to Be Done: <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 />1 hereby certi/y 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 presume to give authority to <br />violate or cancel file provisions of any other state or local law regufafing construction or the <br />perfornmance of construction. That I am authorized by the owner of this property to perform the <br />work for which application is made and 1 comply with the State Contractors Law 18.27 RC W and <br />296.200 WAC. <br />11- U(c <br />Signature Dale , <br />RI <br />