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� <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETi, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857—www.everettwa.org <br />, APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> � ' � l��Ll�'�` �� S�. /� .) O Z <br /> PROJECT ADDRESS <br /> MO�r 1Y\1.� �� N�� C. lal1L^�I'n-a � �l-"- 1 �Q rJOy )a�j� <br /> Owner Mail Address o � <br /> City p '�StaafE iP Phone <br /> ��m_r_r I r o.- �oN s �+,..-..c 3 c �..,. <br /> Tenant '� <br /> Mail Address City State/Lp Phone <br /> z� 3s '3 L� <br /> �lzc��, c � 1 lccl.,v+ob . �., • t�� 13 • ��-^s <br /> ax ���Z. St,�h�,....�. 1 L � � 33 1 <br /> Electrical Contractor Mail Ad ress � City State/Zip Phone <br /> �' �� � ii � G1�2Du � lll��' Ch� ;s ����', � <br /> State License Number Contract Price of Work <br /> l�7-� <br /> Proposed Use of Bwiding Contact PerSon (P�an Review) <br /> Description of Work to Be Done: �a� � "� �,,� J�1 q� y„� �Q v �, P S <br /> �O �x ��'STi�w� � �-�� 1� Cr �'�� <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 certi/y that I have read and examined this application and know the same to be t�ue and <br /> correct. All provisions ollaws and ordinances govern�ng th�s type o/work will be comp/eted <br /> whether specified herein or not. The grenting of a perm�t does not presume to give authority to <br /> violate or cancel th ovisions of any other state or/ocal/aw regulating construchon or the <br /> performance of nstr ct' . That I am au n by the owner of this propeRy to peAorm the <br /> work lor which pp/ic ' n ' and I mp/y th the State Contractors Law 18.27 RCW and <br /> 296.200 W . <br /> � <br /> ,_ � , " 3 <br /> ' Signature �—� ale <br /> �a4�l-o�J <br />