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� I <br /> ELECTRICAL PERMIT APPLICATION �i <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 4M TO 4 PM <br /> / <br /> _ � �l �. C( i7/�' <br /> PROJECT ADDRESS � <br /> d lC1< �Z.P �—?��—E <br /> OWner Mail Address Ciry Stale/Zip Phone <br /> Tenanl Mail Address City State2ip Phone <br /> C�/(t�:�J'��� <br /> EleClrical Conlraclor h7ail Address Cily Slale/Zip Phone <br /> Slalo License Number ConUacl Price of Work <br /> Proposed Use of Building Conlacl Person (Plan Review) <br /> Description of Work to Bo Dono: � %,�< ' � o� r:�/'��c % ' C��— � <br /> NOT[: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEINAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby ceriily fhaf I have read and exami��ed(his applicafion end know fhe sarne fo be true and <br /> conacL All provisions o(la�rs and orrfinances govemmg fhis type ol work wiil be compfefed <br /> whether speci6ed hemin or noL The granting ol a pernut does nof resume to�ive authonty fo <br /> violafe or cancel the �rovisions oI any ofher stafe or local la�r reguPfi;ig construcfion or fho <br /> perlornrence oI cons�nrcfion. Thaf 1 am aufhonzed by the owner o/this propert}�to pedorm the <br /> worh lor which application is made an 1 compty�rith the Stafe Contractors Law 18.27 RC W and <br /> 296.200,t4�AC. i <br /> �i <br /> ���� ��z�:r,:���� C,� - ��� : ,- z�� - �� <br /> ` Sipnriure Date <br /> .EO�G�-�( �/ <br />