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, <br /> ELECTRICAL PERMIT APPLICATION <br /> GITY 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 /> I � I 4� 1NL�w�care, �v � <br /> PROJECT ADDRESS <br /> ( � �� <br /> ��., ��tiv��� <.;�zs)3��-Sy53 <br /> Owner Mall Addross Clly Stale2lp Phcne <br /> Tenanl Mail Addrass City SWIe/Zip Phonc <br /> 1'��1c. ���-4� t l�c-1�; � G� l,-�c._ (yzs) z S Z - �I �S��- <br /> ElecUical Conlraclor Mail Address City State2ip Phone <br /> I'V�C,L-��1J E��1�3 N J <br /> State License Number'� Contract Pnce o(Work <br /> Proposed Use of Buildinc� Conlacl Person (Plan Roview) <br /> Doscnplion of Work lo Do Donc: 1�•l.�.V\�Q.. �K��T��1� � r^ �I �V� <br /> J � <br /> _ ��JZ \.�'> �UC� Uw�l�l U�/'�(��VC�J��� �L� � \�� <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> ''l� <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certily fhnf I have read nnd exnntined this applicafion nnd know fho sarne fo bo fruo and <br /> con�er(, All provisions o(/aws and ortiinances govemmg fhis type ol work will be complefed <br /> whe(her speafied herein or noL The granting ol e penmf does nof resume to give aidhonty to <br /> riolale or cancel fhe provisions oI eny ofher state or locol law reguPting cons(rucfion or the <br /> oerfomiance oI consl�ucfion. Thaf 1 am aufhorized 6y the o�tiner ol fhis property fo perfomi the <br /> ivork!or�rhich applicefion is made and 1 cornply�vifh fhe Sfafe Conlractors Law 18.27 RCW and <br /> 29G.200 WAC. <br /> � �l/�� d /�—Z� z �'? �G;j, <br /> � nal0 e , ___ Date � <br /> ��a-�y� <br />