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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVEREI-T, V�JA 98201 <br /> 425-257-8810 - FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> L��D� MEI2Ri�L !'RE-�=K PKw��L�� <br /> PROJECT ADDRESS <br /> 20� -32s'-��o� <br /> WA R E N-����NF.� Gh'���P (�no uNlVEl�.siiy sT" � 282o SE�°+TiL.E h/A 9�10� <br /> Owner htail Address Ci1y State/Zip Phone <br /> Ro�.�.s GZoy c_e y 2,y-tiS i • sooa <br /> Tenant Mail Address City Stale/Zip Phane <br /> y 2S-77s-'7�i 4 y <br /> Slf NT��1�1 ( t C (o30a ME12R��L C2CEk AKW�/ CVE12ETt" WA �{�243 <br /> ElectnCalConiraCtot MailAddress Cily State/Zip Phone <br /> � C�U� SI (a1�11_ �► 9� 6 �TF <br /> State License Number Contract Pnce of Work <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Descnption of Work to Be Done: �NS�T�-1 L Lf��fl Of�l 0� Y � LL L'M l N F�TF]� �K Z�121�2 <br /> S I 1 fV — <br /> � <br /> I NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 9705 <br /> !nemby certi/y fhat I have read and ea�amined this application and know the same fo be frue and <br /> correcL All provisions oI faws and ordinances 9ovemmg this type o/work will be comp/efed <br /> whether specilied herein or noL The grantmg ol a permd does nof p�esume fo give authority tc <br /> violate orcar,cel fho pmvisions olany olhersfafe or/ocal/aw regulahng construction orthe <br /> peAormance ol consfruction. That 1 am aufhonzed by fhe owner o/fhis property fo peAomi the <br /> �vork lor which applicafion is made and I comply�vith the State Confracfors Law 78.27 RCW and <br /> 296200 LI�AC. <br /> SignaWre Oale <br /> � d� to - ISd <br />