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ELECTRICAL PERMIT Ai�PLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERElT, WA 98201 <br /> 425-257-8610 - FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 P61 -DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> � C,� �� (T�.��,..,.,,;� 1�.�,,;E_ <br /> PROJECT ADDR S <br /> K;,af•n,� .f�rc«„� <br /> Ownef Mail Address City \ $� e/Zip Phone <br /> �� Iq �° ' � <br /> Tenant MailAddress Ciry Staterzip Phone <br /> �ir���,c �: ��re �r.�i. 1nc 14�91L S7i1�/��f. S �. S•v:�c.+�sl. (.t.;9 �}S19G _�o� �9/-���3 <br /> Electrical Contraclo� Mail Address City Stale/Zip Phone <br /> /Uc. -r� � cn9�' F9�- ���; � <br /> Stale License Number Contract PricQ of Work <br /> Proposed Use of Building Contact Person (P�an Review) <br /> Description of Work to Be Done: _�c•-/ /Oe� !-�i,.� �r°,,,�� ,���/e -��,^ /l r'�ac��� � O-F <br /> � / <br /> /��G«s � . /-�Ci�n�P: �l� ri� �.1 ��. ����^.c /�r C'Ai«'�tK � <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 he�eby cerii(y fhat I have mad and exantineA fhis r�pplication and know the same to be fn�e and <br /> correcL All provisions olla�vs and ordinances governmq this Q�pe o/work wi116e completed <br /> whe(her specified herein or noL Tlre grtviling oI a permd does not resume(o give aulhonty fo <br /> violafe or cancel fhe provisions oI any olher stafe or local law reguPting construction or Ihe <br /> peAorrnance o/construclion. Thaf I am aulDorized by tne owner ol lhis property to perforrn fhe <br /> work lor which applicalion is made and 1 cornply wifh Ihe Stafe Conlractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> i � <br /> . � <br /> � <br /> r.' , <br /> � <br /> I1 :`��_�_ L=: ��r.� J`-IG L'- c <br /> Signature Date ' <br /> �aso� �9 � <br />