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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 — wvrvv.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />C e vi 1 D It i UQ <br />PROJECT ADDRESS <br />Iyr*gC!A Srlltl of 12e)F') 'aL'eklIL 0eIoe E0P_Ytir71. a_ 9'Ea) q 57Y6O <br />Owner Nail Address City State/Zip Phone <br />"AV'A—e <br />Tenant Mail Address city State/Zip Phone <br />PoSl Xll%e ta-Kp- yzs <br />ClreTf`ll Tne ';e_, 1-5 5teVe <br />Electrical Contractor Mail Address City State/Zip Phone <br />PLC-IlTe zc)1z-1 q o ff)n <br />Slate License Number thtract Price of Work <br />Ae -'j I'v <br />Proposed Use of Building Contact Person (Plan Review) <br />Description of Work to Be Done: �n/�{ fa n L) L tt,'l? A _512 IA <br />fQ <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 />1 hereby certify that I have read and examined this application and know the same to be true and <br />correct. All provisions of laws and ordinances governing this type of work will be completed <br />whether specified herein or not. The granting of a permit does not presume to give authority to <br />violate or cancel the provisions of any other state or local law regulating construction or the <br />performance of construction. That lam authorized by the owner of this property to perform the <br />work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />� m <br />Signature <br />EGIQCI$ V�� <br />