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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, W� 98201 <br /> 425-257-8810 - FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> /'�Q/.�i1�i// �01 �,(J�,� /�/d�� /7 <br /> PROJFCT ADDRESS � <br /> �' �V�UL-'�OQAN�xJ� .T.� i�l'S�b e���' �✓� ] 7L��' !X� �o/��e��� 9a�.ai <br /> Owner�� Mail Address Ciry Stale/Zip � <br /> Tenant Mail Address City Slate/Zip Phone <br /> i'/.A.t='J'7�.2• 'I/G(o <br /> � .Y�.�.,r . �J'r��oi�. E�.u!'_ /�30,� ,�a"�Ae�G 4J ��i�✓i.��s li�,4 �pa�lo <br /> Electrical Contracl r Mail Address City Stale2ip Phone <br /> ��/C = N� �/D °1 _� � <br /> Stale License Number Contract Price of Work <br /> �d7� ��/�O 9 °� �aw��-'. <br /> proposed se o(8uilding ' Conlact Person (Plan Reviaw) <br /> Description of Work ro Be Done: � �N /� � � <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> �� ��� �� <br /> CITY OF EVERETT LOCAI SALES TAX CODE IS 3105 <br /> f hereby certily Ihaf I liave read and examined fhis application and know fhe same to be true and <br /> conect AI!provisions ollaws and ordinancos goveming th�s type ol work will be completed <br /> whe(her specified herein or not.. The gr�nting o/a permit does nof presume to give authorify to l <br /> violateorcancelthe provisionsolanytlfherstateorlocallewregulafingconstructionorthe � �(� 7 � <br /> per(onnance of construcfion. That 1 am authonzed by Ihe owner o/fhis property to peAorm fhe � / <br /> work lor which application is made and 1 comply with the Sfate Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> �•;. ( <br /> � �c./ .C�. �i9� : ,�� � S��il � G <br /> ignalure Dale <br /> /v Y <br />