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�LECTRICAL PERIVIIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES �` f S_� <br /> 3200 CEDAR STREET, EVERETi, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org �0�0(��16�. <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO d QM <br /> ,// G, � 3 � �J ��� �� c..� r <br /> �� <br /> PROJECTADDRESS �%� � - .3 S S1��77 <br /> �latr-e n �� e /.�,�e� e .�e � /,.//G • a3�`✓'ibve �� �✓e'r2� 9�� v_� <br /> Owner Mail Address Ciry StalelZip Phone <br /> Tenanl Mail Address Cily Stale/Zip Phone <br /> ��l_J/9 � Y• — <br /> Cil Stalc/Zip Pho�.e <br /> ElCclf'C31 COnlf�ClOf M11ail Adtlress Y <br /> Stale �icense Number Contract Price of Work <br /> � ' ` �' ContactPerson (Plan Review) <br /> Proposed Use o(Buildinc� <br /> Description o(Work to De Done: �J� 7�"� �� ��r �G��eH /`'—�x ��U ��""'� <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWA'fS, MC OR AC CABLE. <br /> I CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 /�, r� <br /> 7 hereby certily that I have read and exarnined this applicafion and know the same to be frue and �,� L��!/ �w 2' <br /> cnrrect All provisions ollaws and ordinances goveming this type o(work will be complefed <br /> whether specified herein or noL The�ra�tin�o(a pennit does not presume to give authonry to <br /> violate or cancel fhe provisions ol any ofher stafe or local law regulefing construcfion orthe <br /> pertormance o�construction. Tliat I am authonzed by fhe owner o/6iis property to pedorm the <br /> work lor which app!ication is made and 1 compty with fhe State Contractors Law 18.27 RCW and <br /> 29G.200 WAC. <br /> � <br /> � <br /> � , �� OC " �,j l> � <br /> � ���, �. •�- �� � <br /> BignaWre Date <br /> i <br />