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ELECTRlCAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES t(-zg--b� <br /> 3200 CEDAR STREET, EVERETT, WA 98201 �ps-�y�� 37 <br /> 425-257-8810 - FAX 425-257-8857-www.evereriwa.org <br /> APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM -DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> � J /�,� �ilJ� c_ )i�?E�c�-- <br /> PROJECT ADDRESS <br /> � <br /> �c.,,aPv 1,�.,�.s-,v,F,v���9.zss 8�� A�� S. „� ��A �8�3 <br /> OWner Mali AdJress City State2i� Phone <br /> � G i i.7i��i �i✓nJ <br /> Tenant Mail Address City State2ip Phone <br /> / (��✓/.A.� <br /> Eleclrical Contractor Mail Atldress City State/Zip Phone <br /> �00��. F_/ 3 of3� � �3 /o� oat� . o-� <br /> State License Number Contract Price of Work <br /> r�!� <br /> Proposed Use of Building Contacl Person (Plan Review) <br /> 1 . I <br /> Description at Work lo Be Done: �v� n�� / �� <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> -� S�-i'� <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby certily thaf I have read and examined tbis application and know fhe same fo be true and <br /> correct. All provisions o/laws and ordinances goveming this type o(work will be completed <br /> whefher specfied herein or not The grantinc�o/a pemut does not presume to give authonty to <br /> violafe or cancel the provisions ol any other stafe or local law regu/ating construcfion or fhe <br /> pedormance o/construction. Thaf 1 am aufhonzed 6y fhe owner o/fhis property fo perform fhe <br /> work lor which application is made and 1 comply with fhe State Confractors Law 18.27 RCW and <br /> 296.200 WA¢. � <br /> I /// /%,.G^' / <br /> �S <br /> , <br /> Signatu �e <br /> ✓ � �, /` /�� <br /> J �� <br />