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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <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-l — :�L-iti S'� �``�' i�� <br /> PROJECT ADDRESS <br /> l;�l._-�� C7 u.; I �t.� 3 t::z� -16t'-' S+ Evc,-� �� �_;�.- 4B <br /> Owner Mail Address City State2ip Phone <br /> Tenanl Mail Address Cily Slate/Zip Phone <br /> LLJ/it'l <br /> Elec.rical Conlrar.tor Mail Address City StatelZip Phane <br /> State License Number Contract Price o(Work <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Dr.scription o(Work lo Be Done: f� �-, c_;�< <�,f .{-xT h /,�,�y�,r ���.�� �•�/ ���a/ l,�_ <br /> :f- �1�:�� ' .%t:�k2 �.+.�.^ ,.�: �G �-�� ( .� Ar' - <br /> ,.._�_ . <br /> NOT[: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACE�NAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby cerii/}�thaf I have mad and examined Ihis application and know fhe same to be true and E� ��I`� U'�1 <br /> correcL All provisions o/latvs and ordinances goveming this t}�pe o;work wi06e conrp/eted <br /> whether spea6e�herein or not. The granfing ol a pemut does not resume to give authority to <br /> violafe or cancel tbe provisions ul any other state or local law re�uPfiny construchon or fhe <br /> performance o/consfruction. That 1 am aufhorized by the owner of fhis property fo per�orm the <br /> work lor�vbich application is madc and I comply�vith the Slate Confractors Law 18.27 RCW and <br /> 296.200 lNA C. <br /> /. <br /> j � �' /,i <br /> ��'��'��� ,��` .1`�«' C'.�_c_ � � ` a�� ' �',4 <br /> Signalure Date <br /> I <br /> _.. .._.. . . . . _ . _ . ___ . _ ..__.___ _._- _ ___.—__—_— I <br />