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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PER�AIT SERVICES <br /> 3200 CEDAR STREET, EVFRE't-f, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857-www.everettwa.org , <br /> APPLICATIONS ARE ACCEPTED FROM S AM TG 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br /> / l� / 9 - l �`'�'/i �� � � - !3-� <br /> PROJECT ADDRESS <br /> ��Cr�a �-r� .�� l,-�vr- S-r �c <br /> OwnO� Mail Address Ciry State/Zip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> / <br /> �-��/3 G� <br /> S� v J i-e/ 2� i.,C� .% <br /> EleclriCal Conlraclor Mail Address Cily State/Zip Phone <br /> �_�(� tl. 1= C�crr:�c �� JEiz.,tc(=f ��� ��(:�� � <br /> State License Number Contract Price of Work <br /> C_ucti �, S � 23 c „ <br /> Proposed Use of Building Contact Person (Plan Review) <br /> DescriptionofWarktoBeDane: 6,� ��C� � uoic�wG r7o0A vtr.T' �,p� �' M4l« vi' /�>R <br /> i <br /> NOTF: WIRING IN NON-DWELLINGS IS REQUIREU TO FEE <br /> BE IN R,4CEWAYS, MC OR AC CABLE. � /' <br /> ���.�(J <br /> C�TY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> !hereby certify fhat I nave read and examined fhis application and know the same to be true and <br /> correcL All provisions ollaws and ordinances govemmg this type of work will be completed <br /> whether speci6ed herein or not. The qranting of a permrt dces not presume to give authonry to <br /> violafe or cancel fhe provisions o(any other state or local law regulating construcfion or the <br /> performance of construct�on. That I am authonzed by the o�vner of this property to peAorm the <br /> �vork tor which application is made and 1 compty with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> 0 <br /> v �:s�-/ 4 S''L������v l2- z � � � <br /> Signawre " �ate <br /> �=9/2 /3� <br />