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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 z; _OW d��� _O/�( <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> PROJECT ADDRESS <br /> I 4 A57 <br /> rz AA61 1A A 2M I Jgih%�d <br /> Owner Mail Address City State/Zip Phone <br /> Tenant Mall Address City Slalo2ip Phone <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> Slate License Number Contract Price of Work <br /> Proposed Use of Building nn I � I [ Contact Person (Plan Review) <br /> Description of Work to Be Done: 1 4� /i� 3 b <br /> as ger <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 /> 'he <br /> heroby cerfily that I have road and examined this application and know the same to be true and <br /> correct. All provisions of laws and ordinances govemrng this type o/work will be completed <br /> whether specified herein or not. The g I in ng of a pemtrt does not ppros�;on <br /> me fo glue authority to <br /> violate or cancel the provisions of any other atete or/orall <br /> l law regulatincstruction or the <br /> performance of construction. That I am authorized by the owner of thisoperlyfoperformthe <br /> workorwhich application!s meds end I complywlfhtheSfafeContracrs Law 18.27 RCW and <br /> 296.200 WAC. <br /> Signature Date <br />