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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 - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />PROJECT ADDRESS <br />pG % 5 t-t�l JcH,., Y LrS� i�>c'r_ �uUlr-rt /4'r�r C ✓, c.�A `7v"Z� <br />UL U <br />Owner Mall Address city St.3te2ip '�1Z5 ZSZeo?So <br />Vq�nN !— <br />Tenant Mail Address City Stateop Phone <br />O lnlN- iL <br />Electrical Contractor Mail Address City StatelZip Phone <br />i <br />Slate License Number Contract Price of Work <br />Proposed Use of Building Contact Person (Plan Review) <br />Description of Work to Be Dane: <br />R�.tnJr/2-� �� f-toySy /'r`z�✓+.,/S D✓ivt�2_S <br />P 2 as rT r2l <br />NOTE: WIRING IN NON -DWELLINGS IS REQUIRED TO FEE <br />BE IN RACEWAYS, NIC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby certify that 1 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 authonty to <br />violate or cancel the provisions of any other state or local law regulating construction or the <br />performance 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 Slate Contractors Law 18.27 RCW and <br />296.200 WAD. <br />5�17 05 <br />Signature Date <br />