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I <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 <br /> l �U � ���C�r -�� C ,U(/ � <br /> PROJECT ADDRESS <br /> ��1ifs+1' <br /> Owner � Mail Address City State2ip Phone <br /> 5�Z s- <br /> �0%4C� � � � l��L �i.�c,���c /��� (vQiicl`J� C��� j� Zul Zc�"' yloo <br /> Tenanl Mail Address City SUte/Zip Phone <br /> �1� � I �, L/Z�' <br /> �t'�'c'�? Ccn�ut� /Jo 13aY ils� /�vi��� l�c� LvA �z7r ��-�c �Y <br /> Elecirical Contractor Mail Address City Slate/Zip Phone <br /> /l �.�.- � � / 5 G ���, <br /> � Z 2C�C�.U!J <br /> Stata License Number Contract Price ot Work <br /> U F-F���2 S . ( h �fi /1�s <br /> Proposed Use of Building Conlact Person (Plan Review) <br /> Description o(Work to Be Done: �N S � �-� �� l/���� � pA'�� w��+� 'ZU ��S <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 certily fhal l have read�nd examined this application and know the same to be true and �G`�\(.'C-1 1 <br /> correct All provisions o/laws anAordinances govenung Ihis fype ol woik will be completed <br /> whefher specified herein or not The granfing ol a perrnd does not presume fo give aufhonty to <br /> violafe or cancel the provisions o�any other state or local law rngulating consfrucfion or fhe <br /> perlormance of construcfion. That!am a�dhoiized by fhe owner o/fhis property to peAorm fhe <br /> wo�k Ior�vhlch application is made and 1 comply wifh fhe Stafe Confractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> i <br /> �t-� ��_ - /Q-ll-o S� <br /> igna�ure ° Dale <br /> ✓ <br />