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� . <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES � _ as--a S <br /> 3200 CEDAR STREET, EVERETT, WA 98201 [ �c,,,.�`I! � <br /> 425-257-8810 - FAX 425-257-8857-www.everettwa.org �N <br /> APPLICATIONS ARE ACCEPTED FROM 8 A'N TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEP7ED <br /> i v 3[ S (� fe� A.�-z S 1� �+e � C 2 <br /> � /'. n �` - `f--a �'�,-�e� W A �<s'�� <br /> PROJECT ADDRESS <br /> �,lit� ��-r3Cr Y z1 " S 3 <br /> gL� � iZa' t� S� s.� S�cr� �.re,.��(" G�a �r��z.��- =t�r � <br /> Owne� Mail Address City Slate/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> EleCtrical Contraclor Mail Address Ciry Stale/Zip Phone <br /> State License Number Contract Price of Work <br /> ,��-e,,,.�.� c� (I��C�'�... CH..�� <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Descriplion of Work lo Be Done: -1- I C. „ itic� �-.�; � (w� .'�.� a-.--���-�� �'�%�""""� , <br /> _ ��_ <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 CUDE IS 3105 <br /> I hereby cerlily that 1 have read and examined this application and know fhe same to be true and <br /> correcL All provisions olfa�vs and ordinances govermng fhis fype ol work will be completed <br /> whether specilied herein or noL Lhe granfing ol a pennrt does not presume to give authonty to <br /> violate or cancel the�rovisiau oI any othar state or local law regulating construchon or the <br /> performance o/consfruction. Thaf 1 am aufhorized by the owner o!this propeRy to peAorm the <br /> work/or which application ic made and 1 comply wifh the State Contracrors Law 18.27 RCW and <br /> 296.200 WAC. <br /> � . ���_ ��„ �r:. � . 7 - 21" 1 <br /> Si�naWre Dale <br /> .�C'S c�7-(L ) <br />