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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 a 'g —V <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM /1 0 140 <br />t)"' <br />i/ 6 r, `i 11, i,L.iCr- 5C urv, f r3 c c� i r it WR `/9Lt)3 <br />PROJECT ADDRESS <br />DAAjiEr•LG 51iL5 //c• L•511. r7u4cE Sc ttNir 13 FVaiLCETi Wf4- q0 Z-0S <br />Owner Mall Address City Stale/Zip Phone <br />Tenant Mall Address City State/Zip Phone <br />Electrical Contractor Mail Address City Stele/Zip Phone <br />State License Number <br />Proposed Use of Building <br />Description of Work to Be Done: .c , r� veN Rr ens 0tN, - <br />r',Nd .4N i)aJ/kLr Ri c.H J1V/o.—�nC� Ber+�i <br />iN PIAu�. c'r' ✓•iIr« . a3a�rL0 N�..i �5i_�N./ <br />NOTE: WIRING IN NON -DWELLINGS IS REQUIRED TO <br />BE IN RACEWAYS, MC OR AC CABLE. <br />11 1 u GO.C.O <br />Com ract Price of Work <br />5,'72 ✓EN RYOr/s i <br />-%:e (lam 1ZY j)7Ail c'JWarsN <br />Contact Person (Plan Review) <br />M/r C'l�B.NPR I �L CQ C.4! r7KNr <br />1 � uvi ri a rN • ,rvs nlc� PSc IZrirai+'i <br />IV ri<?L N r)115OW4 Ei F_r'e C'A/CNc <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />them 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 nn: presume to give authority to <br />violate or cancel the provisions of any other state or local law regulating construction or the <br />perfomiance of construction. That I am authorized by the owner of this property to perform the <br />work for which application is made and / comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. / <br />S C1 �ZiCr2a z yA <br />Signature/ <br />to <br />.5vZ✓EN rz <br />Au J>,'olG L•EN%e%Dwn'/f 2 <br />owWrcKy uNc� <br />FEE <br />r�l��i�"���y <br />