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ELEC'i RICAL 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 8 AM TO 4 PM <br /> �(�� S�G.'clnueSC Qv.sL GI111 —�3 <br /> PROJECT ADDRESS <br /> _+ 1 Oh+1 S L Il '�03 Se4kuos� p��lLQ,T'l <br /> Owner Ma�l Address City State2ip Phone <br /> Tenant M�il Address City Slale/Zip Phone <br /> Nels�n ���.fiQl< <t�ZS l�n�s� st S��m,s� � 1NI�� q'8L9��qa.� $63� <br /> Eleclrical Contrac�Or Mail Address Ciry Slale2ip Phone <br /> NE� sc�L� o�s�z S400, �u <br /> Slate License Number Conlract Pnco of Work <br /> Proposed Use of 8uilding Contad Person (Pian Revie�� ) <br /> Descriplion o(Work to�e Done: ���- ����. <br /> ?ane I��� oui'(�fiS f YeC�,oi'- <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CA�LE. � <br /> 7S U- <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby certi(y thaf 1 have read anA ezamined fhis applicalion and know fhe same to be 6ue and � l 'Z O� ^ <br /> correcf. All provisions ollaws and ordinances govemmg fhis lype ol work will6e cornplefed - (�� / <br /> tvhefher specifieA herein or noL The granfing ol a perrnd does no(presume fo give aulhor�ty to <br /> violale cr cance/the provisions ol any ofher sfafe or locnl law regulating consfruction or(he <br /> performance o!construcfion. lhat I am authonzed by fhe owner ollhis property(o peAomi!ho <br /> �vork lor which applicafion is made and 1 comply�vilh(he State Confrac(ors Law 18.27 RCW and <br /> 296200 WAC. <br /> t�„--:/��— � — � — �2 <br /> Signature Date <br />