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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 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> � `� ° �' i is� n ,�� ��� 9�ac;� <br /> PROJECT ADDRESS <br /> f� � <br /> /-�;� � «�I �s i�� �; �/ /� �- ,/.v= ��,<' ,4 v.�.✓'✓�>% 9az« .3�7 - S�/� <br /> Owner Mail Address City State!Zip Phone <br /> Tenant Mail Atldress Ciry State/Zip Phone <br /> /_�R/�',rL ��_ �> >3// /^�� ;T�- _ � � �� 3G�'% <br /> E' ,Vc�flri�i5/✓ /��1 rifs' � C• lG� —�1 4!- <br /> Electncal Conlractor Mail Address Ciry � Slate/Zip Phone <br /> /_''/�'/C�� � -1 s� 'C' i <br /> State License Number ConUact Price o(Work <br /> c- c— �C' <br /> Proposed Use o(ouilding Contact Person (Plan Review) <br /> Description of Work to 8e Done: _�q. ,—,Fa /,' f l;(•/�/= i •—- C �/�' G v i T� <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 /> II hereby certilv that 1 have read and examined lhis applicafion and know the same to be true anC <br /> ;;e;rect. All piovrs�ens o/laws and crdinances govemmg fhis t��pe c/work wdl be completed <br /> whether speci6ed herein or not. rhe,ranting of a oermd ooe:. not presume to give authonty to <br /> ��iola:e cr cancel the provisions of any other state brlocal law regulating construction or ihe <br /> performarce of construction. Thaf I am authonzed by the owner o/this prcperty to perlorrn ihe <br /> �vcrk fcr which aoplicaticn is made and 1 comply�vdh the Sfafe Ccntraclors Law 78.27 RCW and <br /> 296.200 lNA C. <br /> i1 i- //�Ii/O ,/� 7 <br /> ��.z-C- �`-� ( �� t'Y',.EiJ-I' ^ �CJ/�J�' /l'�' �/ �� / <br /> Signawre �ate ' <br />