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ELECTRICAL PERMIT APPLICATION <br /> CITti' OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS AR�ACCEPTED FROM 8 AM TO 4 PM <br /> l�aD (�-��11?Gr� <br /> PROJECT ADDRESS <br /> �I G�"!✓1-e ` I\ VL.X Y'�� � 1�`2(�'� ` ' (�f'T< <br /> Owner Mail Address Cily State2ip Phone <br /> Tenanl Mail Address City State/Lip Phone <br /> � -f�, i(e�f��-� 41.� �l/ ��l���o� �,��� vas-a�3a�a <br /> Eleclrical Conirac�or Mail Address Cily Stale2ip Phone <br /> GOWtw�v� �GS�f � ,� ���'dv °� <br /> Stale License Number Contrect Price ol Work <br /> �`e S /�.YI'�-r' <br /> Proposed Use of Building Contact Person (Plan Reviow) <br /> Descriplion of Work l0 6o Dono: �i�5�/9-l� N.ec��) J�{7{¢S� ?�Gr O�/� �-�-�n0 �-� I' <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> 8E IN RACEWAI'S, MC OR AC CABLE. <br /> i <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby ceriily Ihaf 1 have read and examined fhis application and know fhe sarne to be true and <br /> correcL All provisions o/laws and orciriiances govemmg fhis type ol work will be complefed <br /> ivhelher specJied herein or not The granfing oI a pennd does not pmsuma(o give authonty to <br /> violafe or cancel the provisions o/any olher state or local faw regulafing consWction or the <br /> perfonnance o!constniction. That 1 am authonzed b��fhe owner o/fhis propeRy to peAonn fhe <br /> weik lor rvhich application is made and 1 cornpty rvifh fhe Stafe Contrecfors Law 18.27 RCW and <br /> 296.200 lM1�AC. <br /> � ' <br /> l� �� / 7 - 7 / ' �� <br /> �/�gnature Dalo <br /> ���� - /�� <br />