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2� �- ��/ ���- c � � er � ��s���- � � <br /> E�ECTRICAL 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 70 4 PM - DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> /� �7 7h /� <br /> -/ � (TS .S �J� � � �,i:'% � <br /> J <br /> PROJECT ADDRESS <br /> �L } � <br /> Ownef � Mail Address City State2ip Phone <br /> Tenanl Mail Address Cily Slate/Zip phonc <br /> _I�e���� M,�l�� � �e � <br /> Elecincal Contraclor Ivlail Address Ciry StatelZip Phone <br /> '�E U�v� N�'� G �4 ��� <br /> Slate License Number Contract Price of Work <br /> . <br /> C-51 '(✓\^I� �� I <br /> Proposed u:e of Building Conlact Person (Plan Review) <br /> Description o(Wurk io Be Done: _ / �rQ�+ ��t1iu �A)� f � b�C'� <br /> NOTE: WIRING IN NON-CNJELLINGS IS REQUIRED TO FEE <br /> BE ItJ RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certily thaf 1 have read and examined fhis application ana;;now the same fo be true and <br /> coriecL All pravisicns o!laws and ordinances governm�fhis type ol,vo�k will be completed <br /> whethe�spec�6ed herein ornoL The�ran(in�o/a pennd does not n�suaie fo give authwdy fo <br /> violate or cancel the provisions ol any ofher sfate or local law ieguPtin�construclion or the <br /> pe�lormance ol construcf�on. That I am au(horized by the owner ollh�s property to perlonn fhe <br /> work lor which applir.ation is rnade and I cornpfy�vith fhe State Contractors Law 18.27 RCW and <br /> 29620U WAC. <br /> �/ <br /> �--�� �7 z � �;_ <br /> c� ture - Date <br /> � �07/3/ � <br />� <br />