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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX425-257-8857—v✓ww.everettvva.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PROJECT ADDRESS <br />�'Ax_ > n .� 1Il.���5 <br />Owner Mall Address Gty stat-Op Phone <br />Tenant Mail Address City StateZlp Phone <br />< <br />.1NL_ tc t ( Ii L 1 <br />;�aCr2��rr .� u /?u� W <br />EleclricalContractor Mall Address city Stateop Phone <br />Slate License Number Contract Price of Work <br />�� c•.��:�� /I L L-/2S ?I (IC- OSSC: <br />Proposed Use of Building Contact Person (Plan Review) <br />• i � j 1, <br />Description of Work to Be Done: <br />NOTE: WIRING 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 />1 hereby ceni(y that /have read and exarttined this application and know the same to be true and <br />corrocf. All provisions o(laws and ordinances govemtng this type of work will b3 completed <br />wftether specified herein or not. The granting of a permmt does not pres�me <br />to give authority to <br />violate or cancel the PProvisions of any ofller state or local law regulatinnstruction ortheperformanceo/constructton. ThatIamauthonzed by the owner of thispertytoperformtheworkfory Nchapplitionismde and 1 complywittheStateContracLaw 18.27 RCW and <br />296.200 WAC. <br />Signature Date <br />Fna`r (-00 Cl <br />