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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 />PROJECT ADDRESS <br />6/) v <br />Rct(rMOt�r 3YY-33G5` <br />Owner Mail Address City StateOp Phone, <br />Tenant Mail Address City Staleop S , one <br />FCedrr`C 1�e6(-4 S2� 3/�E Arlr'vts�o-�l ll/� ��� 3 3 -�'3/l�, <br />Electrical Contractor Mail Address City State/Zip Phone <br />51131 <br />Slate License Number Contract Price of Work <br />(_ 1\ <br />Proposed Use of Building Contact Person (Plan Review) I <br />Description of Work to Be Done: QVic a.v <br />P rP�fr'(Q/y 1 <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 certify that 1 imavo read and examined this application and know tho same to bo true and <br />rrorrecf. All provisions of laws and ordinances governing this type of work will be completed <br />whether specilled herein or not. The granting of a permit does not ppresume to give authority to <br />violate or cancel file provisions of any other state or local law regWating construction or the <br />performance of construction. That 1 am authorized by the owner of this property to perform the <br />work for which application Is made and I comply with the State Contractors Law 18.27 RCW and <br />296.200 WAG. <br />-1 -7 -. 2 <br />gn lure tv Dale <br />F_1007—(3c1 <br />