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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR S1 REET, 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 />' l ='C�. . � � / 9 � �� a <br /> , „� <br /> PROJECT ADDRESS <br /> �-Jpl:�: � It . '�1 / n��N ::� l l��a. J � q r`�1.<. � VT ✓t � �J'✓� C/ ����rJ <br /> Owner Mail Address Cily Stale/Zip Phone <br /> f�t r� ^- <br /> Tenant Mail Address City Slate2ip hone <br /> �?6 0 <br /> l_. �. 1_:�� r,� r�� C Tt�; c l ,G. ,b�ox �2GT� /V.�Ah'eWa�c� W�19825�� 6�3 <br /> Electrical Contrector Mail Address City Stale/Zip Phone <br /> IJ /h/G CON7� <br /> Slate License Number Conlract Price of Work <br /> r'. o ���r � s�, �r� <br /> Proposed Use of 6uilding Contacl Person (Plan Review) <br /> Descriplion of Work lo Be Done: �,J rn�1• L l� C. �� 7 S l�"r f� 'Y� "7 �i fa Ca {�tcP e S�r �}:� <br /> NOTF: 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 /> I hereby ce�tily fhat 1 have read and examined fhis application and know the same to be We and <br /> correct All provisons o/la�vs and ordinances governing this type o(work wrll be completed <br /> whefher spec�bed herein or noL The granfing o/a pennd does not resume to give authonty to <br /> violafe or cancel the provisions o!any other state or local law reguPting construchon or the <br /> perlomrance oI cor�sfrucfion.--T iat 1 arn authonzed 6y the owner o(this property fo perform fhe <br /> work lor�vhich applicafiai is m<�e and 1 comply with Ihe Sfate Contractors Law 18.27 RCW and <br /> 296.200 WAC. 1 <br /> "' -;`Cl-_--/ ��� �/p 6 <br /> Signature Dale <br /> � <br /> �G�.�;�'� <br />