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kv c <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR ST EET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 7 --- /Q— d�7 <br />DO <br />�(vl(, ?2 S� /`( `Y��a I <br />PROJECT ADDRESS <br />Sao Gjr,mm /!o/(, 3Z Ja- ;41 /L! �i . cl`f I IvA &j.GZo 1 Wd_.3_0 viz <br />Owner Mail Address City Stale/Zip Phon^ <br />Tenant Mall Address City State2ip Phone <br />�lylct'ut+1cJ 12 o 13Jx 9///3 Jea a. �vA 2k/// 5_Z4. J-W <br />Electrical Contractor j Mail Address City Stataop Phone <br />0 Yb o-jl' 4 (P _i-2 , 2,3 <br />State <br />License Number Contract Price of Work / I - <br />Proposed Use of Building Contact Person (Plan Review) <br />Description of Work to Be Done: <br />V I-ve lit. I <br />NOTE: WIRING IN NON -DWELLINGS IS REQUIRED TO FEE <br />BE IN RACE!"/AYS, MG OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 b a�. -04 <br />I hereby certify that I have read and examined this application and know the same to be true and Ca a <br />correct. All provisions of laws and ordinances governing this type of work will be completed <br />wti therspecified herein or not. The granting of a permit does notpresume to give authority to <br />violate or cancel the provisions of any other state or local law regulating construction or the <br />performance of consWction. That I am authorized by the ownerof this ropnrty to perform the <br />Work <br />2 0 WAC application is made and I comply with the State Contractors Lew 18.27 RCW and <br />Signature - Date <br />