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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.everelt�va.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> i.' : <br /> PROJECT ADDRESS <br /> OWner PAailAddress Cily StatelZip Phone <br /> . '-i .. - .' , • . � . . . ,, ; • <br /> Tenan� Mail Address Cily . StatelZip Phone <br /> .t . , '. , - . . � . . <br /> EleclricalContraclor MailAddress Cily � Slate2ip Phone <br /> �' <br /> �'Ii^ <br /> �. :� /L ';�.. ,� �1 !". i", • .� i;, � ^ <br /> State License Number Contract Price o(Work _ <br /> 1 ' <br /> /' /�,' ..;_ .>-.,. <br /> � . . ��' i,"�/�' � �� � <br /> Proposed Use of C3uilding Contact Person (Plan Reviev+) <br /> Square Footage Qf residenlial new construction,remodel or addition) <br /> ^ i; <br />-. . �, , i.;- � , <br /> Description ot Work to Be Done: 1 � "�' � ' � `� ' � � " ' <br /> � <br /> NOTE: WIRING IN NON-DWELLINGS IS R[QUIRED TO FEE <br /> BE IN P,4CEWAYS, MC OR AC CABLE. / � 'r',� <br /> �� <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br /> I hereby certily that 1 have read and examined(Dis applicalion and kno�v the same(o be true and <br /> conect. FlII provisicns o//a�vs and ordinances 9ovemmg(his type ot�vorlc ivill be ccrnplefed � I 1--I Q — Q�� <br /> �vhetherspeci�ed herein ornoL Thc granting o(a pernuf docs notp resunte to give aufhonty(o <br /> violate orcancel the,•�rovisions o/any others(ate orlocalla�v regulafing conslruclron or(he <br /> peifo�mance ol consf/uclion. Thaf 1 mn authorized by fhe owner olthis properiy(o pedorrn flie <br /> r a�k Ior n�hich applicafion is made and 1 comply��ifh!he Slate Conh�aclors Lnu�79.27 RCW mid <br /> 296.200 WAC. <br /> � , : , � <br /> ��/l� �� i���� � — <br /> � Signelure Dale <br />