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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERV!CES <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 /> 1�i���,�i �o� P,�w,, ��d���� <br /> PROJECT ADDRESS <br /> �� ��U��DOAf1/',Jr �71P "�13 �b epG n.i4'� itVQ 1TL��UO �n�/tNb � 9a�,a� <br /> Owner Mail Address Clty Stale2ip � Phone <br /> Tenant MailAddress City Stale/Zip ����� ���� <br /> ��J7L, /J' -/e� ;!� n ����SJ JJa'I"��o� 6J ��ih/i.��i,,,l�.4 �.Po:lfo <br /> Elecirical ContraC r Mail Address City Stale2ip Phone <br /> �i'lG��=NF ;�o � a� � <br /> State License Number Contract Price of Work <br /> A�� /�I�IO � ./_//AQ/1 �i'I".C...,,.�r,/ <br /> Proposed se of Building Conlact Person (Plan Reviow) <br /> Description of Work lo Be Done: � �//1� //G�L) OC� l�N i7 A�'� /� ��P <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> �� 3�� ">.� <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> !hereby ceAi/y thaf I have read and examined fhis application and know fhe same to 6e true and <br /> correct. All provisions ollavis and ordinances goveming fhis type oI work will be complefed <br /> whether specdied herein or nof. The grp nting of a permd dces not presume lo givn aufhonfy to <br /> violate or cancel the provisions ol any Other state or local!aw regu/ating consfruction or the <br /> perlormance o/consWction. That 1 am authonzed by it�e owner ol fh�s property(o perfonn the � <br /> work lor which application is made and 1 comply with the Sfate Confractors Law 18.27 RC W and f l�/ <br /> 296.200 WAC. � <br /> �'' ^ � � C 4� 3 • /!r -D l• <br /> � Q.u� C . IJ1 - i1c�=.r. <br /> Sign ture Date <br /> �oCoO 5 — /lv � <br />