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( <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 /> Z523 P � Nc ,T <br /> PROJECT ADDRESS <br /> 5�'-��--`�� �r��1�x�ck Z523 PW6 �r �v��-1} WA `1F(�.-v ( +-125-�t79 '6S16d <br /> Owner Mail Address Cily Stale2ip Phone <br /> Tenant MailAddress City Slate2ip Ph��ro <br /> � r,� Sra�., Eb��ia�c :�-•nc. ZZ3o ,��....,.s A� �v�ai-�t cJd 98Zc;3 <br /> Electrical Contractor Mail Address City Slale2ip ��2 S.Zc�a Phone <br /> 7G3c� <br /> PREsr�z q �3 ��c �����/�2 � � sdd.� <br /> Slate License Number Conlract Price of Work <br /> S �-. n <br /> Proposed Use of Buildinc� Contacl Person (Plan Review) <br /> Descriplion ot Work to Be Done: �'v�:,.;�C�: C� fY�..� S " �'{"E�T � �� �Qc�c� <br /> �.�o�a�- �_���- <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 CI��_�� <br /> I heieby certily fhaf 1 have read and examined this application and know fhe same to be true and <br /> conect All provisions o(la�vs and ordinances govenung fhis type ol work will be completed <br /> �vhelher specdied herein or noL The c�ra�nfing o/a permd does nol resume to give authority fo <br /> violafe or cancel the�rovisions ol any other stafe or local law reguPting constniction or fhe <br /> peAorrnance o/construction. Thaf 1 am authorized by fhe o�vner ollhis propeRy to peAomi the <br /> work/or which application is made and 1 comply u�ifh the State Contracfors Law 18.27 RCW and <br /> 296.200 WAC. <br /> �j,.,^^ �-�S�,d— '1 - ��- rc.� <br /> Sic�naWre Dale <br />