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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.evere wa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />�-►05 Mot(�� Ate, �>Ac� <br />PROJECT ADDRESS <br />`I 2� <br />rAl �e�5o►� 1-l�Sb'1 r n Rc� 1� v�rz�� [J� 93j }i3%� <br />Owner Mail Address City State/Zip Phone <br />Tenant Mail Address city Stale/Zip tJ �Ph <br />�o•>;tioz E10_Ar %L ShC, (,a-zo 00A s%✓eng COA I? 33573gyq <br />Electrical Contractor Mail Address city State/Zip Phone <br />PC S I �+ T r) �C Contract Price of Work <br />State License Number <br />ke-5.13ey1CL <br />Proposed Use of Building ` Contact Person (Plan Review) <br />Description o1 Work to Be Done: J C l) I L. e \�\A 1\A(' 1 * I S (S) Wy h <br />Pcw•c- ��T 'Tf-TA01 �� CIw-r)%gS-- <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 certify tlfat I 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 v.,ork will be completed <br />whether specified herein or not. The granting of a permit does not resume to give authority to <br />violate or cancel the provisions of any other state or local law regulating construction or the <br />penfonnance of construction. That 1 am authorized by the owner of this property to perform the <br />work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />4 / r r VlCf <br />_ <br />Signature Date <br />1� <br />