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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />1°!GU /Ili LL S/= <br />PROJECT ADDRESS <br />5' ll 1) 1' k- 95C0 /9��Av sC ��zc71- <br />Owner Mail Address City State/Zip Phone <br />4El, ic;i, IYte F<r-1,�e �c L,i�i�iw�D�l ��u. 9So?7 <br />Tenant Mail Address Ci y State/"Lip Phone <br />)Db--?ii-qq <br />Electrical Contractor Mail Address City State/Zip Phone <br />late License Number Contract Price of Work <br />l <br />Proposed Use of Building Contact Person `(Plan <br />�Review) <br />Description of Work to Be Done: <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 certify that I have read and examined this application and know the same to be true and <br />correct. All provisions of laws and ordinances governing this type of work will be completed <br />whether specified herein or not. The granting of a permit does not presume to give authority to <br />violate or cancel the provisions of any other state or local law regurabng construction or the <br />performance of construction. That l am authorized by the owner of this property to perform fhe <br />wcrk for which application is made and I comply with tire State Cortraclors Law 18.27 RC W and <br />296.200 WAC. <br />Signature Date <br />i <br />�o6il- <br />)7 <br />