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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 <br />PROJECT ADDRESS <br />1= le.- <br />Owner <M I Address City State/Zip <br />Phone <br />Tenant Mail Address City State/Zip <br />Phone <br />Electrical Contractor Mail Address City State/Zip <br />Phone <br />$ `D <br />State License Number Contract Price of Work <br />eC7\/-2f4 L oor"`\-� C' c E� k <br />— <br />Proposed Use of Building Contact Person (Plan Review) <br />Description of Work to Be Done: C t 4AA 4Cb Ate- VV'CaA one I t C-0 OM `SC tLVa <br />c,v�, cc wtct- (3� czrif� _NC, Lot) &a O Z <br />IJo�1w��' Cm�nnr' �'k pro �) c.o.ler� wcr`L_ �uti�-t+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 Q — <br />}f <br />I hereby certify that I have read and examined this application and know the same to be true and D I 03 <br />correct. All provisions of laws and ordinances governing this type of work will be completed <br />ii <br />whether specified herein or not. The granting of a permit does not presume to give authority to <br />violate or cancel the provisions of any other state or local law regulating construction or the <br />performanc fconsfnn��Jlton. That 1 am authorized by the owner of this roperty to perform the <br />work for Mitch a licah'on"I rr de and I comply with the State Contractors Law 18.27 RCW and <br />296.200 <br />IZ <br />Signature Date <br />