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� � <br /> ELECTRICAL PEIRMIT APPLICATION <br /> CITY OF EVERETT I�ERMIT SERVICES <br /> � 3200 CEDAR STREET, EVERETT, WA 98201 <br /> I 425-'L57-8810 - FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PiIA - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> '�S"v3 s��p, �� <br /> PROJECT ADDRESS <br /> 1` G � _ <br /> Ownef Mail Address City State2ip Phone <br /> Tenant Mail Atldress City State2ip Phone <br /> � G �j6d� <br /> I� �uw+ ������C ��cc . y�j2`� �O�nhakac p� fr'�-�s••^�. (�t,0. 9Szv9 329 ,2z-Z9 <br /> Electrical Contractor h�ail Address � City State/Zip Phone <br /> I�(,��� .� MC 4n���1 <br /> State License Number Contract Price of Work <br /> (•�`,.s\ tl-�J��'ih � �\O �� <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Description of Work to Bo Done: � �,,..(� ('�,C <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIR�D TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> 1 here6y certify that I have read and examined this application and know the same to 6e tue and <br /> conect All provisions ollaws ar�d ordinances goveming this type o/work will be completed <br /> whefher speci(ed herein or noL The granling o/a permd does not resume to give authority to <br /> vio/afe or cancel the provisions ol any other state or local law reguPting construchon or the <br /> perlormance o(construction. That 1 am authonzed by fhe ownerof this prop:�ty fo peAorm the <br /> work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> ��aS ��C -�'! �`L 3 • �`1 <br /> �— <br /> S' na re Date <br /> � 07 -/ / � <br />