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i <br />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 - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />PROJECT ADDRESS <br />BA LA i-t3uf`.V1;1& iC, I-175 \N %'Aariyte.li;ey) Dc &jeq;1[ l WA 98201 <br />Own Mail Address City State/Zip Phone <br />gC"U ?Sur_V\ICdYic_ V-11jSW.May-iyA&eWDf. FVareAt, JA: 93201 (4Z4Z2 1-291tc <br />Tenad j Mail Address city State/Zip Phone <br />Yl\}YG�[TILt+�L. Z'L21 Ca\.�nrrlia Sk. F_-'j2ry. WA C1,9 0) /472-9*9-3t;5 <br />Electrical Contractor Mail Address city State/Zlp Phone <br />Sf ntl�l xzltN►C � 14`i:S. " <br />(State License Number 1L Contract Price of Work <br />Ruk_ } i(-y P 1'(ACl 11 l l.t \k Ike_ (:)Wemcior <br />Proposed Use of Building Contadq Person (Plan Review) <br />[lescription of Work to Be Done: 1 V\CA-aA\A::" 0,'\ Of (OIJJ V0P. SCtAY� . <br />i <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 certify that I have read and examined this application and know the same to be true and <br />correct. All provisions of laws and ordinances governing 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 />performance of construction. That 1 am authorized by the owner of this property to perform the <br />work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />1 -_ J <br />OOrrn SrLSfLy t II�S�C>L( <br />Slgnqtdre Date <br />c�ll — 033 <br />