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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.o g <br />E 09 <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />5o II Seakurs-I- Ave. <br />PROJECT ADDRESS <br />SI_eve.n 7, 'Uoreib5 So// Sect. mUT S4 Ave, Evem->< f, 04 98'd c 3 _ <br />Owner Mail Address City State/Zip Phone <br />owner (571)21-1--0001 <br />Tenant Mail Address City State/Zip Phone <br />owner - <br />Electrical Contractor Mail Address City State/Zin Phone <br />Slate License Number Contract Price of Work <br />(fie 5 a-e/1ALI a.1 0 tJ Ae � <br />Proposed Use of Building Contact Person (Plan Review) <br />Description of Work to Be Done: l e le C-�r I C cJ re c.,p I1 t c e 5 <br />NOTE: WIRING IN NON -DWELLINGS IS REQUIRED TO FEE 1 <br />BE IN RACEWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 .�� <br />I hereby certify that I have read and examined this application and know the sarne to be true and Ll " r� V �� v <br />correct. All provisions of laws and ordinances governing this type of work will be completed <br />whether specified heroin or not. The granting of a pemut does not presume to give authority to <br />violate or cancel the provisions of an}, other state or local law regulating construction or the <br />performance of construction. That i am authorized by the otvner of this property to perform the <br />work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />(Diog <br />/Signature V / Dale <br />J <br />