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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 <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />PROJECT ADDRESS <br />Rom- t'4?74806 <br />Owner MN GT Mad Address City State/Zip Phone <br />Tenant Mad Address City State/Zip Phone <br />No- "M I I& 30 `I61' &. �i. �ktn�1 WA 9 ab 03o y2.5.724-%9 <br />Electrical Contractor Mail Address Cob State/Zip Phone <br />P207-E CT 165� f �71�1)'� <br />State License Number Contract Price of Work <br />9x;s/1 Lr.L.1/1,11 <br />Proposed Use of BuilqA Cont ct Person (Plan Review) ` <br />Description of Work to Be Doneems„ yJv G E Q 'AAqj�' S`-- <br />(�sC:sG t£ S•.lt �H E S Sri <br />U,T "TS t�'� `�_ ^hula - R_Z S iJ o �.o�.laEr� P\-J SuG <br />Nee t A �tD T i iC C"E-t �.% Thk £ LS o L <br />NOl E 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 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 not ppresume to give authonty to <br />violate or cancel the provisions of any other state or local law regu afing construction or the <br />performance oJconstmction. That I am authorized by the owner of this proporty to perform the <br />work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />,Sig re Date <br />�j qci 9 <br />