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r ( <br /> 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 -DEBR 8 CREDIT CARDS ARE NOT ACCEPTED <br /> �� �'� l� W <br /> PROJECT ADDRfi S <br /> �Y.�� �C C i �_r1`�-.{ �C!1. '^� Sr%.rti..r �1,� C�'-1 <br /> Owner MailAddross City Stale/Zip PMne <br /> Tenanl Mail Address City Stalc2ip Phone <br /> �C�� - <br /> I-lili e �;1 4�1i- �l- VQ�., k,t ��C� �-I��. ���� Sr ����-i. , I,��-`l �3�IO�S ����a5i,� <br /> EleclncalContractor MailAddress City SWlelZip PMne <br /> A w cs��a�,sgi� ����i. �'i,, <br /> Stale License Number Contract Price of Work <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Description of Work to Be Done: A �(Yl �1-�Cc !1ti'� <br /> NOTE: WIRING IN NON-DVVELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. � <br /> �� <br /> CITY OF EVERETT LOCAL SAILES TAX COCE IS 3105 <br /> I hereby certily tha(1 have read and examined fhis applrcation and know fhe same fo be true and E��y"''��� <br /> correct. All provisions of laws and ordinances governing fhis type of work will be completed <br /> whetherspecified herein or noL The granting o/a permR does notp resume fo give a��honty to . <br /> violate or cancel the provisions of any ofher state uNocal law regulatiny consWction or the <br /> peAormance ol consWction. That I am aufhonzed by fhe owner ol this property to pedorm fhe <br /> work Inr which applicafion is made and 1 comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> �'c��-c�Ce.�C�''— �-(�l�l�� <br /> SignaNre aIe <br />