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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 425-257-8R57 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />12/0 t wz y zS <br />PROJECT ADDRESS 3oc? <br />r 12ED .4�-T��k' /3/o IV�y(,4,a dy Ell ��-�� Wy <br />Owner Mail Address City State/Zip Phone <br />Tenant Mail Address City Stale/Zip (i )S, Phone <br />7 <br />0E N12�12- secs 3��x k � �V 91:2&1 �5 �.61 <br />Electrical Contractor Mail Address City State/Zip Phone <br />tFf­%-,4jkuy /�z Z L /D <br />Slate License Number Contract Price of Work <br />S,c /L <br />Proposed Use of Building Contact Person (Plan Review) <br />Description of Work to Be Done: /� �*�Li r�{��/� 641yieL I // !(SEC n 1- i e;F <br />NOTE: WIRING IN NON -DWELLINGS IS REQUIRED TO FEE <br />BE IN RACEWAYS, MC OR AC CABLE. / 6 <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 5 <br />F—ov¢Od -tQt1 <br />I hereby certify that I have read and e,,.amined this application and know the same to be We and <br />correct. All provisions of laws and ordinances goveminy this type of work will be completed <br />whether specified herein or not. The granting of a permit does not presume to give authority to <br />violate or cancel the provisions of any other state or local law regulating construction or the <br />perfomiance of construction. That lam authorized by the owner of this property to perform the <br />work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />Cfo <br />nature oe Date <br />