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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERET'F PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 -www.everettwa.org <br /> APP_ICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> ;, 1 � <br /> �\ �C S•' <br /> PROJECT ADDRESS <br /> Owner M11ail Address City Slate2ip Phone <br /> Tenanl Afail Address C�ly StatelZip Phone <br /> i.�� ,- r_-�: � a�:� �c�. rr��s� zEi�_ v, �_ r,�,�ti, �� i,�n �,�-��� ��,� ,��.t�so� <br /> [lectrical CoNraclor R1ail Address City State.2ip Phone <br /> 1J r-E� r.,_ �.��% ; ,;.�� 1� �f sc� <br /> Slate License Number � Contract Price of Work <br /> �1 <br /> �i'•l. � l r�.f.t ��:. <br /> ProposeJ Use�of�Ang Conlar.l Person (Plan Revicw) <br /> DescriptionofWarklof3eDone: i- ? I- 'i�,�1 � , r"=. ,- - - �c� ii. { I�rrrn �1���� ; -� �� <br /> ��' �:'cf�,.�1� r-�r��` = � ..� ��1 �' �0�: ��rrS f E �. .��l�u �� �crrt � .tvtL <br /> �, ,� • <br /> NOTE: WIRING IN NON-DWELLINGS IS R[QUIRED TO FEE <br /> DE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 �/ ryy� <br /> 1 hereby ceridy llial l ha��e m.Aand exarnired(his applicn(ion and kno�r the sarne to be true and �_l,l� �lJ - ��J� <br /> conecL All pravisians o//a�vs and oidmances�ovetning this type o�work�rill Ue cornpleted <br /> tvhether specilied herein or rtot The grmfing o/a pertnd docs not �resmne to�ive authonty to <br /> violafe or r.ancel fhe I�rovisions ol any otlier sfafe or bcal lo�r regul.�fin�construcfiai or fhe <br /> peAormance oI cons(rucfion. That 1 am authorized by fhe ou�ner ol ihis property fo perform(he <br /> �vo�k lor�vhich application is rnade and 1 comply with!he State Confracfors Law 18.27 RCW and <br /> 29G.200 11'AC. <br /> i . <br /> _ � ,�� ,� , ;. <br /> .-- �Sign�Luc� .-/'� 'Dato ' <br />