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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.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> /�n �r��//CQ.� O.c�, � i� is� <br /> PROJECT ADDRESS � <br /> � /' /✓� J��nn �',� c�•/? <br /> Owner Mail Address Cily State/Zip Phone <br /> Tenan� Mall Address City State2ip Phone <br /> J, � //, �� U2 <br /> ���� 9���v.3�5. <br /> �//� C�/.JiJL✓ f` �/lir PV �F �/�^v�i� 'f%�""� Il' �.� li/,�nd,�s �A /,ID�Cv <br /> Electrical Conlrad f Mail Address Cily Slale/Zip Phone <br /> � U�' <br /> `7�IC'.t'��l � '�n J � �5 ao — <br /> Stalo License Number � C�Nract Price of Work <br /> ,I �--s,i) N � <br /> r� - —11"� <br /> Proposed Use o uilding Conlacl Person (Plan Review) <br /> `—� /� <br /> Description oi Work lo Be Done: � ,/'^' ••� r'/1 d/� —. <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 that 1 have read and examined fhis applicafion and know the same to be frue and <br /> conect All provisions o(laws and ordinances governuig this type o/work will be completed <br /> whether speci(eAherein or not The granting o(a pemut does nof presume fo give authority fo <br /> violate or cancel fhe provisions of any ofher sfate or local law regu/afing consWchon or the <br /> perlomiance o/consfrucfion. That 1 am authonzed by fhe owner of Ihis property fo pedorm fhe <br /> work/or which applicafion is rnade a 1 comply wifh the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. / <br /> 1'� "%l� � � /S� v� <br /> ,� <br /> gnature Dale <br /> ,� .�� <br /> � <br />