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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—wny�y,everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT$CREDIT CARDS ARE NOT ACCEPTED <br /> _ ;:�oi �� ,�5 sf <br /> PROJECT ADDRESS <br /> L A �- r�y C�. ve 1.��� 1301 C�A �s 5-�- 9XaD( <br /> rL'J2 r,Z� aOl. q -ri7 91/ F{ <br /> Gwne� Mail Address C�h, �� � <br /> StateZp Phone <br /> Tenant MallAddress <br /> City State/Zip Phone <br /> � �Lec�'r�� �.��� �o3C7 �Q.v.-T I.JvY <br /> ElectncalContractor MailAddress ��35 �S3RKa D$yQ <br /> C�ry S�t�p Phone <br /> � a�g � � � �'13� ��v <br /> State License Number <br /> ConVact Price of Work <br /> Proposed Use of Building <br /> Contact Person (Plan Review) <br /> Description of Work to Be Done; (��(J C1 r y� �e • <br /> -- S e,�r ✓ i L 2 1 o riZ (Q <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO <br /> BE IN R.4CEWAYS, MC OR AC CABLE. FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceRify that I have read and examined this applicsfion and know the same to be frue and <br /> whether spec/fed herein�or not nThe g anting o%a perm9t does not presume�to gi e�authonty to <br /> violate or cance/the provisions of any other state or loca/law regulatrng construcUon or the <br /> wo�k foo which appl ca con�s�made and l c mply w th fheeStaf e Confra�ctcsPLaw f8.27 RCW and <br /> 296.200 WAC. <br /> �.LL`=-o�'�'I �l�i iF � � ( Q�l l <br /> Signature ^ � <br /> Dale �/ <br /> / � (/ <br /> � <br /> Eosvz-or�l <br />