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ELECTRICAL PERNlIT APPLICATiON <br /> CITY OF EVEFtETT PERMIT SERVICES 9�7--�b <br /> 3200 CEDAR STREET, EVERETT, WA 98201 � / <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org C f QOCJ� D °� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> !�c.�� �_. ��<) -;�i �1�� "7� - <br /> PROJECT ADDRESS <br /> '/�J! <br /> � /� � /`/! / � �.'� �� `7�' /—vG�L- 17� `�U� ;���=�F' <br /> l ���� r ,�� �r�� Cil Sta�e/Zip Phone <br /> Owner � � Mail Address Y <br /> Tenant Mail Address City State2ip Phone <br /> ")u� ,� - [���n ,� "�„� Phone <br /> Electrical Conlractor � Mail Address C:ty Slale2ip <br /> State Licen;e Number Conlract Frice of Work <br /> Proposed Use of Building Contacl Person (Plan Review) <br /> Description of Work lo Be Done: " + - `��' � � �� �i7"c2 e-� � ���`�"�` <br /> NOTE: W IRING 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 /> r l ��� ' �''Z�P <br /> 1 hereby certi(y fhat I have read and exarnined this application and know the same to be fruo and �.�, <br /> correcL All provisions of laws and ordinances govemmg this type o(work will be completed <br /> whelher specified herein or noL The�ranting o(a permd does nof presume to give aufhonty fo <br /> viola(e or cancel the provisions of any ofher state or local law regulating construchon or the <br /> periormance of construction. That I am authonzed by fhe owner ol this property to perform fhe <br /> �vork lor which application is made and 1 comply with fhe State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> � a <br /> �" —/O <br /> ���J� ., �l v` �!r /�^� r - 1 <br /> SignaWr� � Date <br /> � <br />