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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES q_7-o S <br /> 3200 CEDAR STREET, EVERETT, WA 98201 �� <br /> 425-257-8810 - FAX 425-257-8857 -www.everettwa.org C �50�7`� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br /> � iuiq r����i ,�i� - r-��=,���� N�,��, Fllr�_� <br /> PROJECT ADDRESS <br /> /vin,-�nr� _Cr� � ,�_ ��ve�t��n� 2��10 I..x.�-n�r � Avc �vr��e-1� i,.lA-Rg�o � �i �5-.�3� -3L�as <br /> Owner Mail Address City � Stale/Zip Phone <br /> 11�1LI ' -�l ,� ll-F�lere+-FI-I�„, � A IoC ����-4-� i,. � 9�01� <br /> � <br /> Tenant M " Address City Stale/Zip Phone <br /> 41s-330-Yluo <br /> BM-� S��i� �eruti(�S 1iu21� ��}1�-11 -Eve�.4.��- Nwq C,,��Fe F12�M�11 C'i�c�t LJ� �'01� <br /> Eleclrical Con a� Mail Address State/Zip � Phone <br /> BR T � r��` jG� Pr'�. � 'la� oo .��,.� ,.�_ ,;;�) <br /> State License Number Contracl Price of Work <br /> I:c I��Izr f Vt;�nk �'�c�nzctl '�C <br /> Proposed Use o(Building Conlact Person (Plan Review) <br /> DescnptionofWorkloBeDone: T1�S-�ti�� ( i" hc ,l °� � C�r NiS�ItiU <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 /> I hereby certily tfiat I have read and examined fhis application mid know the same to be true and <br /> conecL All provisions o/la�vs and ordinances governmc�this type o/�vorh will be completed ., <br /> whether speci6ed herein or noL The granting o/a pennd does nof resurne(o give au(hority to <br /> violate or cancel Ihe provisions o(any ofher sfate or local law re�uPfing construclion or tne <br /> perlannance olconsfruc6on. That I am aufhorized by the owner oI this property to peAorm fhe <br /> �vo�k lor which�pplicafiun is rnade and I comply ivifh the Sfate Contractors Law 18.2/RCW and <br /> 296.200 W <br /> i <br /> / _� ' r _ <br /> � <br /> I; � <br /> � �. c � <br /> Si ture Date <br /> i� i <br /> �_ � <br /> l � _ 'i .� <br /> � <br />