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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 3 �) u _0 e <br />425-257-88,i0 - FAX 425-257-8857-wv✓w.everettwa.org C 0!?03-071 <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />S� <br />�✓cr���- <br />PROJECT ADDRESS <br />�Orkt C-4 �)('j <br />Owner Mail Address City State/Zip Phone <br />t- 116� b i, 1 J v 1)f.. t-i 6/Flrr <br />Tenant Mall Address City State2ip ' Phone <br /><� �tCr_4"�C a6�06yLvS1 �•i.( �cnn W� 7903� <br />Electrical Contractor Mall Address City State/Zip Phone <br />$ O' J <br />j�IJIC }I t111510y (5-0 <br />State License Number Contract Price of Work <br />Proposed Use of Building Contact Person (Plan Review) <br />Descriplior. of Work to Be Done: PC I� <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 />1 hereby certify that I have read and examined this application and know the settle to be true and <br />correct. All provisions o/laws and oMlnanca governing flristype o/ work will b i completed <br />whether specr0ed herein or not. The granting of a permit does not pre&imo <br />to give authority to <br />violate ur cancel ffra provisions of any other stafe or local law regulatinconstruction or the <br />peifornance of construction. That I am authorized by the Owner o/thiropertyoperformhework for which application is made and 1 comply with the State C0n(rars Law i8 27 RC W and <br />296.200 WAC. <br />Signature ate <br />