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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.evereftwa.org <br />C- I'ZO,5 057 <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM S <br />PROJECT ADDRESS <br />Owner Mail Address City State/Zip Phone <br />Tenant Mail Address City Slate/ i � Phone <br />1�{D,y�_ <br />Electrical Contractor Bail Addre 5 City Stale/Zip Phone <br />�iIDD- <br />State License N mber Contract Price of Work <br />n <br />Prdp'6sed Use of Building Contact Person (Plan Review) <br />Description of Work to Be Done: caP <br />x- <br />NOTE: WIRING IN NON -DWELLINGS IS REQUIRED TO FEE <br />BE IN RACEWAYS, MC OR AC CABLE. 50 03 <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105TT <br />1 hereby certify that I have read and examined this application and know the same to be true and i Z(�s'" v�T <br />correct. All provisions of laws and ordinances governing this type of work will be completed <br />whether specified herein or not. The granting or a permit does not presume to give authority to <br />violcte or cancel the provisions of any other state or local law regulating construction or the <br />peAormance of construction. That I am authorized by the owner of this property to perform the <br />work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br />296.20 AC. <br />Signature Dale <br />