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07'll'@009 11:4P PdS 1fi0G5194:15 C:1N1'I\ Ii\'I' 1\C <br />fmoo�ioot <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES �� � g <br />320D CEDAR STREET, EVERETT, WA 98201 7' <br />425-257-8810 - FAX425-257-8857—www.everettwa.orp L ��U7,�� <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />��/� ,Pvc�s� f�UE�t/UE <br />PROJECT ADDR�SS <br />Owner <br />Tenant <br />ElecUical Contrador <br />l'.9s¢ur�'.z'9y / C J� <br />State License Number <br />Proposed Use ut Building <br />Mail Address <br />Mall Address <br />Mall <br />Ciry <br />Ciry <br />ciy <br />Sta�HZip <br />State2ip <br />SlalofLlp <br />�',�ODD . <br />Cont2ct Price of Work <br />Contad Person (Plan Reviaw) <br />■. : �. � � . � � 1 /./ / : ♦ <br />N01E: WIRING IN NON•DWELLINGS IS RE�UIREO TO <br />BE IN RACEWAYS, MC OR AC CA[3LE. <br />CITY OF EVERETT LOCAL SAL�S TAX CObE IS 3106 <br />1 hereby cvMiJy fhat 1 haw road and exeminetl fhis application antl know [ho samo to be (ruo and <br />conect. All provisions o! laws and ord�nancos 9ovenung fh/s fypo of wcrk wdl be compintod <br />whothor speci�od ho�cin or noL Tha gmnting ol n pomut doos nut /esume to give aufhonty (o <br />violalo or canro/ �ho provisions ol eny ofher stefe or local law repuPting censbudion or fho <br />padnrmance o7 cvnstructiort Thaf I am aufhorized by tho owner o! fhis propsrty fo poAorm fbe <br />work !nr which applicafion is made and 1 comply with tho State Confiactors Lnw 78.27 RCW and <br />Phone <br />Phmro <br />Phone <br />FEE <br />7s°` <br />- <br />Cy�v� - OS� <br />