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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, 1NA 98201 <br /> 425-257-8810 - FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> I � oz Ru �keR uve <br /> PROJECT ADDRESS <br /> )P FF �oalol0 1 �OZ RurkcPqve kvP.�e�T �4 QSZo� 2S83a — <br /> Owner ldail Adtlress City Stale2ip Phone <br /> Tenant MailAddress Qry Slate/Zip Phone <br /> f� fP�fa -�D�]e94tle�Jd%zL�� 9s313�s u�e�E 6veR�lT u/9 9,�208" Y�3373 <br /> Eledrica�Conlracto� MailAtltlress Ciry State/Zip Phone <br /> AIP�}qne 962/s6 /,2 v� <br /> State License Number ConTPrice of Work <br /> �e5 -'De� Ce� <br /> Proposed Use of Building Contad Person (Plan Review) <br /> �JD i / p /;� ,,)/) n <br /> Descnption of Work to Be Done: /� l. !/� (�e �li T��� � "'� S� [/C/l1�Q� /r!� <br /> .Sra,P <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 J105 <br /> 1 hereby certily fhat 1 have read and examined lhis applicafion arrd know(he same to bo Inie and <br /> correcL All provisions ol la�vs and ordinartces qovernmg fhis type ol wo�k will be complefed <br /> whefher specilied herem or not. The granfing o/a permd does nof presume(o give aufnonty to <br /> wolate or cancel fhe provisions ol any ofher slafe or local law regulaling conslnicfion or fhe <br /> pedonnance olconsfrucf�on. Thaf I am aufhonzc-d by Ihe owner o!this property fo peAorm the � <br /> �vork lor whicb application is made and I comply wilh(he Sfale Contracfors Law 78.27 RCW and � <br /> 295.200 WAC. <br /> � <br /> � � . <br /> 1/'l��'`�'�-�I Y� 3�z�0 Z� ��� L� <br /> SignaNre °� <br />