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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8II10 - FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> ;;� � y�YL= s�S w ��,-f�r°�� <br /> PROJECT ADDRESS <br /> � t� � <br /> /�;��Y 5{��-r-.�r�s ��i�rSl4,IY �I�-�, , S `"��"f:�: I�� t[,r7 Y�� 7G <br /> Owner �.1ail ddress � Cily State/Zip Phone <br /> Tenanl Mail Address City State/Zip Phone <br /> ' / � � �j �_ /— /� .L . C <br /> L_�G_( (-/r �c -:t;� 5���"7 Gl /i� /�c �:��..�y Sc.. r ;ric� l�'L7c, 1�S�7Ci S <br /> Electricsl Conlractor t�;�il Address Ciry � State/Zip Pnone <br /> �I, —7 <br /> L;.'�'�r ,�/ �' l:�r' � i'� � �l' / CiC_:C/ <br /> Statd License Number Contrect P�ice of Work <br /> j�y 'c�. �C�r�S i �;�� ,_ S _�- _ <br /> Proposed Use of Building Contacl Person (Plan Review) I <br /> Description o(Work to Be Done: /,'/��� i�� �� lii;✓,j-r /S �J�' SC.�� <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES iAX CODE IS 3105 <br /> 1 heieby certily that I have�ead and examined this applicalion and know the same to be true and <br /> conecf. All provisions ol laws and ordinances govermng th�s type ol work will be comp/eted <br /> whether speci6ed hr.rein or not. The grantin9 o/a pennrt does nof presume fo give authonty fo <br /> violate or cancel(he provisions o(any other state or local law regu/ating consfruction or the <br /> perlorrnance o�construc6on. Thaf 1 am authorized by fhe ownero/this property to peAorm the <br /> work lor which application is made and 1 comply wifh the State Contractors Law 18.27 RCW and <br /> 296200 WAC. <br /> � - ��f�._,.,� � ,;'`__'� / C ��c•�G '7 / ��� <br /> Signature �—� Dale , � C <br /> � � <br /> �I � I <br /> V <br />