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ELECTRICAL PERMIT APPLiCATlON <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREE?, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.e�!erettwa.org <br />AP?LICATIONS ARE ACCEPTED FROM B AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />�/� J /% �7 <br />PROJECT ADDRESS <br />����ii' [/Cs`%'7✓'0�'-� "�/F� /i' .;,i Cii=r`-- l.CJ'e `l�2S-�.i�3-1Y <br />Owner Mail Address Ciry StatelZip Phone <br />Tenant <br />Eleclrical Conlractor <br />��i�ca� /3':=� % <br />State License Number <br />�--�1-/ ///�ii//— <br />Proposed U'se ot Building <br />MailAddress <br />Mail AdAress <br />Cily <br />City <br />StatelZip <br />%Zl2 % `?2-'- �� 3�, <br />SWtelZip <br />�� <br />/�u"U <br />Contract Price of Work <br />Conlact Person (Plan Review) <br />Phone <br />Phone <br />DescriptionofWorktoBeDonc: %� Z i=.�/�-�; �� pr�T�r-'-`� /�=�;��i�{-,�i � La/}�7_=T,' C��/'<��o.�rt� . <br />NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO <br />BE IN RACEWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby certily tha� i have read and examined fhis applicafion and know the same to be true and <br />correcl. All prov�sions o/ laws and ordinances governmg this type c( work �vi(I be completed <br />whefher speci(ied he�ein or noL The �ranting o( a pernut does no( resume to give authoiity to <br />violate o� cancel fhe provisions of any ofher sfafa or local law reguPting construcfion or the <br />peAormance o(conslruction. That 1 am authorized by the owner olfhis properiy fo pederm the <br />�vork /or which application is rnade and 1 compty with fhe Stafe Conhactors Law 18.27 RCW and <br />296.200 WAC. <br />.[ ��� i�i�✓ `� � K:' ' ( �v � <br />SignaWrc ' Dale <br />FEE <br />�C�G"�i - � 7 9 <br />