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ELECTRICAL �'ERIVIIT APPLICATION <br /> CITY OF EVERETT PERMIT �ERVICES s�7 ��� <br /> 32Q0 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857—www.everettwa.org C Q�� s—� � <br /> API'LICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> �� � `1 `rti` Fl i�. SC. 5� ; f� Ill� <br /> PROJECT,aDDRESS <br /> OWner Mail Addreas Cily StatelZip Phone <br /> � 1<'..� )LrL1Ai1 � <br /> Tenani A!ail Atldress Ci4; I /�al�/Zii� Phone <br /> � � IV <br /> �r5 � c �� 1Q�� � cn '-ll����;;il�= �JA- 7����0 »c;- c�s i-� 3�i <br /> Eleclrical Contraclor Mail Address City StatelZip Phone <br /> �5 Z l.C'. 4�� t'� 22 C'Y 7 ��, oo� <br /> Slale License Number Contract Price of Work <br /> � T �<> ° �-r I P `rI P)�^ F <br /> Propoaed Use of Building Conlact Person (Plan Revie:v) <br /> Description of Work to Be Done: i'C�I� �rc- N �"iC. /�E�N r'�5� '��'�l�C w S y �c•.ti c�( S <br /> �!_��'_, t ffht:ti,7�d;'; � � S� �✓�'i <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITf OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 heieby certily tha!1 have read ar.i exarnined Ihis application and know the same to be true and ��i�Q S" �y(� <br /> conect. All prowsions o(/an�s ann ordinances�overning this type o(v k will be cornp/etea <br /> whelher speciGed herein or noL The granfing ol a pernut does not reaume to give authonty fo <br /> violafa or cancel fhe provisions ol an}�other state or local law ieguPting conslruchon or the <br /> peAonnance ol construchon. Tltat I am atdhorized by the owner o(this property to perlerm the <br /> work lor�vhich application is made and I compty wifh fhe Stafe Confractors Law 18.27 RCVV and <br /> 296.200 WAC. <br /> � /� � n 5 � —L�l <br /> _ G'�. <br /> �� - .,a � �- <br /> .ture J Dale <br />