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ELECTRICAL PERMIT ApPLICATION <br /> CITY OF EVERETT PERMIT SERVICE� <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 /> �, �1 �{}`,�� � _54) <br /> PROJECT ADDRESS <br /> ��G� S�� �� ��,�� <br /> OWnef Mail Address City State/Zip Phone <br /> Tenant A-0ail Address Cily State/Zip Phone <br /> C��� -����/�c. <br /> Electrical Contraclor ldail AdCress City Slate/Zip Phone <br /> /,��/�.�f�,�c��7��z <br /> State License Number Contracl Price of Work <br /> ProposeA �'se o(6uilding Contact Person (Plan Review) <br /> _ / �y_ �J � <br /> Description of Work lo Be Done: L'l�-s�'�-l� y� ��C:��,��Lc✓ � � �I.�� <br /> i <br /> ��i / 4/-�,7/� i <br /> -3�4 • � OLG� G�C.��'c%C `� �4� C�X'-r_C[_ ��L� ��� <br /> � /GJ�� � <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 _ � ,_ r�_ i <br /> /� \ <br /> I he�eby certily tha(I have read and examined fhis application and know(he sarne ro be true and (.� L�� i i.�` /�: <br /> cor�ect. All provisions oI laws and ordinances go��ernmg fhis type o/wo�k�vill be completed <br /> whether speu(ied he�eirt or noL rhe granting o(a pennit does nof resume to�ive authorrty to <br /> violate or cancel(he provisions oI any othcr stafe or/ocal law reguPting consfruchon or fhe <br /> peAorrnance o/consfruction. That I am authorized by the owner ol this property fo pedorm the <br /> �vork Ior�vhich applica(ion is rnade and 1 cornpty v�ith the Sfate Contractors Law 18.27 RCW and <br /> 29ti.200 WAC. <br /> � � <br /> i.�' �� � � , � <br /> �� �=- -�_.L(- �/ls�C-G::c� =-�<<L� �� ��� .� <br /> SignaWre Date � <br />