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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 42:,-257-8857 — wvdw.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDiT CARDS ARE NOT ACCEPTED <br />1/(' �j iJ ((�'l����/_ I('� f5/v'r7 ��J«etl w�t `'�(jLv 3 <br />PROJECT ADDRESS <br />Owner <br />Nail Address <br />City <br />3�� <br />�,s�r <br />��=� �/`d•'-7/ 3�,3�1 <br />SWte2ip Phone <br />��c�.n�.� lM.l rr� I lC��l (n� l�`'1 u r, ITev %ta���,/ rv��f� 4�a 95�203 �+zi -3s9- Z79K's <br />Tenant Mail Address Ciry SWte/Zip Phone <br />Contraclor Mail Address <br />o�u n� [- ,- ,�,� c� y�/ (' z <br />State License Number <br />7i n c - ,. �-�•�� <br />Proposed se of Building <br />�52zj 3Go-'/SS-S/2� <br />State2lp phone <br />2 �� r�c�. ��� <br />Contract Price of Work <br />Conlact Person (Pian Review) <br />Description of Work to Be Done: S u �,�", %, �};� � OU �/{�Y� (� Ca �� i Cr n c t S�'r v� G� <br />NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO <br />BE IN RACEWAYS, MC OR AC CABLE. <br />CI7Y OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />! hereby ceRi(y that f have read and examined fhis application and know the same to be true and <br />comecf. All provisions of laws and ordinances goveming this type o/ work will6e completed <br />whether speafied herein or noL The granting of a permd does not presome to give authonry to <br />violate or cancel the provisions o/ any other state or local law regulating consWctfon or the <br />peAormance of construchon. Thaf 1 am authonzed by the owner o( this propeKy to pedorm the <br />work Ior which application is made and 1 comply with the State Contractors Law 18.27 RC W and <br />296.200 WAC. <br />� ���;� �:. <br />2-Z-o <br />�ascz-a`{ <br />FEE <br />