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( <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETI' PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857—www.everethva.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> G7 6 �� Wf1�S t'� I r1 u '� N f}-c/F <br /> PROJECT ADDRESS <br /> � r_oMk�, 1�� ��� <br /> Owner MailAddress Gty SWte21p Phone <br /> Tenant Mall Address Ciry Slate/Lp Phone <br /> �L - P'L- !Z/'cS�,� f�.l�l-�c-��e (•�/c 33Z2 !3z"� ST S `^J �7�/�vwo.� <br /> Eleclrical Cantractor Mall Address Clty SlaleZp Phone <br /> �c' �GTE i �� � � 3L 2 < 00 - ,-" <br /> State Ucense Number Contrad Price of Wark <br /> �7< < � 1 �^f(� <br /> I Proposed Use of Building Contad Person (Plen Review) <br /> I <br /> Descriplion of Work to Be Done: � � " �" L � � ���' I_� �� h T u l� Q.�l F � <br /> n�Tw 3���E5-Ts ���w,�s 30 �f►- <br /> , <br /> NOTE: INIRING IN NON-DWELLINGS IS FEQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> 1 hereby certi(y thaf 1 hevo read and exemined thts applicatton end know the same to be fnie end <br /> correcf. All provlslons o/laws and orcllr,ences govemtng fhls rype o/work will be completed <br /> whether speclfied herein or not. The grenting o/a pertnif does not presume to glve authoriry to <br /> vlo/ate or cancel the provlsions ot any other sfate or loca/law regulating conshucNon or the <br /> perlormance o/constnict7on. That 1 am aufhonzed by the owner o/thls property to perform the <br /> work lor which applicafion!s made and 1 comply wifh the Sfate Conhactors Lew 18.27 RCW end <br /> 296.200��A�. / ' <br /> ��--�-, ��- 3 - �v <br /> Signature Date � ' � /� <br />