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I <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES � _ a _o � <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-88�7—www.everetriva.org �b �0--01� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT AC.;EPTED <br /> ,)(1I � �Wlt � �j �T - <br /> PROJECT ADDRESS <br /> Owner Mail Address Ciq• State/Zip Phone <br /> 1��G�r"�� /)�ilAL�i��2'iill; �,�'�7 �/ll �/t 5� Fvt'rf�f l-Ul7 <br /> TenantJ �ress City StatMZip Phone <br /> I�Pu,�-��[•�� �e�v.,ii�vi/a �i���< I�L� iSnz 11Sb' 7J� �h; ���i� [.Ui� i��'27`, <br /> Electrical Conlraclor Mail Adtlress City Slate2ip Phone <br /> � �. � (�� d <br /> /UtG�> TtC'. "I. I `.�(tT�n ' r� ?�5I. 57� <br /> State License Number Contract Price of Work <br /> (� c,,�,��ri �' i��� J��ni �E�i/�5 <br /> Proposed Usc of Building Contact Person (Plan Review) <br /> Description of Work to Ba Done: �� t�I �-�cl � � ��� 1)i� i L ' l'[l 7�f S � �.,� _C� CI�LI ��l���{St <br /> I Ut:���� � �„�: (�l�!�� r� � �S �)' �'C IL f �I-"f���, r ('�]���_4 <br /> NOTE. WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cemh�fhat!have read and ea�ammed this apprication and know the same to be!rue and <br /> correct. All p�cvisions of laws and ordinances goveming th�s type o/�vork wdl be completed r � � U '� � U j v <br /> �vhethe�spe�ciLed herem or nct The granfing o/a perm�t oees nctp resume to give authority to <br /> vrelale or cancel the provisions oI any other state cr local law regulating consWction or the <br /> peAcrmance o/censtrucnon. That I am aulhonzed by the owner ol th�s property to peAoim the <br /> �vc�k Icr wnich application is made and I comply wdh fhe State Confractors Law 78.27 R�W and <br /> 296200 WAC. <br /> �,u' _ � 2 c�� <br /> . SignaNre �ate <br />