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r <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 !O -/3�1/ <br /> 425-257-8810 - FAX 425-257-8857-www.everetlwa.org G ///D_O,?D <br /> APPLICATIONS ARE ACCEPTED FROM e AM TO 4 PM <br /> � I o � y P�� �►� 1� ��� <br /> PROJECT ADDRESS <br /> Owner Mall Address City Stale2lp Phone <br /> Te�ant Mail Address City State2ip ��8 <br /> �i;iGs f=�e�-�-v��� >3� 2s�� J�'.�f�W s�hwo� l��l-�S292 _ <br /> Electrical ConUactor Mail Addresa City State2lp 3(ed 3,�a���, <br /> GJ�,rk l;.�0 32Ka ��� '� � <br /> Slate License Number Contract Price of Work <br /> Proposed Use of Building Contad Person (Plan Revlew) <br /> Description of Work to Be Done: I ' ��� I1�1 �� ' �� <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO �E <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 here6y certily thaf 1 frave read and examined this applicetion and know the same to 6e true and <br /> correct. All provlsions o(laws and ordinances goveming thls rype ol work will6e complefed <br /> whether speci�ed herein or not. The granfing o/a permR does not presume fo glve aufhonty fo <br /> vlolate or cancel the Provisions o(any ofher state or local law regulatlrg construction or the <br /> pe�formance of constructlon. That 1 am aufhorized by the owner olthis property to perform the <br /> work for which application!s mado and 1 comply with the Sfate Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> ���. �°-1 � --��� <br /> i nature Date <br /> E 1 IIG � d7D <br />