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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 & AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> 7C.'� � 1\�( �( ��'✓ �'"f_UC <br /> PROJECT ADDRESS <br /> �� I <br /> � ��- � F1rv�� • L � <br /> OWnef M11ail Address Ciry StatelZip Phcne <br /> 5i�1-��,� <br /> Tenanl M11ail Address City SfatelZip Phonc <br /> I,���. �kNr'� ��r��r�. �nc. S-5�w 5-Gter;-ci���� GfZ'�wr}r -����5 f.J�- ���-2 <br /> Elecirical Conlractor Mail Address City� ,,� State2ip Phone I <br /> �i� � -G�'(-��7 Z <br /> �/�CK�CZ �L� �2 _��1� ' /5�� =' <br /> , <br /> Stale Licecse Numbcr Conlract Price of Work <br /> i <br /> ���,tit . j:,y.�r1 ;' S1�•rc,9� <br /> Proposed Use o(Building � Contact Person (Plan Review) <br /> Description o(Work!o Be Dane: ��.' ����� 'Z��✓`-'J KO� /� .S�%1J�e� GJ. � � <br /> / - ��.�, -4 T����'��.- as.,...:Jl ! - /cx� �9 i-���er- . <br /> � <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CiTY OF EVERETT LOCAL SALE.:TAX CODE IS 3105 � <br /> i hereby certity lhat I have read<rd examined fhis applicafion and kno�v the sarne to be lrue and r C.';'1�/�1 — 01 �f' <br /> eor2cL All prows�ons ol laws and ordinances governmg this type ol�rork will be completed <br /> �rhether speci6ed herein or not. The 9rantiny o/a pe�md does not presume to give authonty to <br /> viciafe or cancel fhe provisions o/sny othe�state or local law regulaling crnstruction or the <br /> performance ol censtrucfion. That 1 am authorized by fhe owner o/this property to peAorm Ihe <br /> �vorh lor which applicalinn is made and I comply wifh the Stafe Contractors Law �9.27 RC67 and <br /> 2962Qd WAC. � <br /> � I � / <br /> ��. . ` ( � �/ <br /> �.I,l .�� �����''v \,�`- � l �! -._.' / <br /> �� S1gnaWre ! Date <br /> � <br />