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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX425.257-8857-www.everetlwa.org 7—tw--11 <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />6 /5 7S1' 11 7 3 <br />PROJECT ADDRESS <br />i1'// 3cr9oro 6/S 7SI' SE 1173 Fvtrr%� f✓^. 9AZO3 425-lW-745' <br />Owner Mail Address City State/Zip Phone <br />N1A <br />Tenant'/ Mall Address City State?Jp Phone <br />170 4& no'13 4zS 98y aw <br />Electrical Contractor Mall Address City State/Zip Phone <br />14s1o� S'ZS <br />Slate License Number Contract Price of Work <br />to <br />Proposed Use of Building 1 Contact Person (Plan Review) <br />Description of Work to Be Done: Ae1W tar r <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 some to be true and <br />correct. All provisions of laws and ordinances govemin9 this type of work will be completed <br />whether specified herein or not. The granting of a permit does not ppresume to give authority to <br />violate or cancel file previsions of any other state or local law regulefing construction or the <br />performance of construction. That I am authorized by the owner of this roperfy 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 />§ nature ate' <br />