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I ( <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR Sl'REET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857—www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> IIaNq l9='ll-vE SE cl-s.�-loc.v s��voR u� ��t�+) <br /> PROJECT ADDRESS <br /> GWne� MailAddress City SlatelZip Phone <br /> 3(i0^ <br /> wR`�FFI►.►Gron� � �.ars�-� 11`�11 113 ME SE r�O¢�rr w�4 f8tosr se�-4'sp'f <br /> TenBnt Mali Address Ciry StatelZip Phone <br /> ADT 11824 North Creek Parkway North 11105 Bothell, WA 98011 <br /> Electrical Contractor Mail Address Ciry StatelZip Pnone <br /> ADTSESI(�3205 �s� <br /> State License Number Contract Price of Work <br /> �� ��� <br /> Proposed Use of Building Contacl Person (Pian Review) <br /> Description of Work to Be Done: I em <br /> /�r�� L'CT✓ 5Ys� <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 heieby certily that I have read and examined fhis application and know the same fo be hue and <br /> correct. All provisions o//aws end ordinances govemfny this type ol work will be completed <br /> whether specified herein or not. The grenting o/a permR does not prasume to give authoriry to <br /> violate or cancel the Frovisions o/any otherstate orlocal law regulsting constniction or the <br /> perlormance ofconstruction. That I am authorized 6y the owner ol this property to per/orm fhe <br /> work/or which application is made and 1 comply with fhe State Conhactors Law 18.27 RCW and <br /> 296.200 WAC. <br /> �� ���� �/ZJ�/�.� <br /> Signaturo ata <br /> �dSD/ - l/3 <br />