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PROJECiADDRESS <br />� lil'�: <br />Owner <br />Tenant <br />Electncal Contrador <br />State License Number <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 6 AM TO 4 PM <br />� <br />Mail Adtlress <br />Mail Address <br />f�� l <br />Mail Atldress <br />re-tn � � nlc�rl�cat ec�� �f n��c na �'/� �AS <br />Proposed Use of Buddmg � <br />Descnption of Work to Be Done: <br />� <br />NOTE: WIRING IN NON-DWELLINGS IS REQUIR[D TO <br />BE IN RACEWAYS. MC OR AC CABLE. <br />CITY OF EVERETT LOCAI SALES TAX CODE IS 3105 <br />I heieby certdy Ihat I hevB mad <br />conect Alf pravisions ollaw; a <br />whelher speci�red horern or not. <br />violafe orcarrcnl the prowsions � <br />perfomience ol cbnslrucfion TI <br />work lor whrch applrcalron rs ma <br />296.200 NAC. <br />City <br />Gry <br />Ciiy <br />� W � ��� <br />SlatelZip <br />State2ip <br />;1uK�ltr� Cc��' <br />State/Zip <br />--�i� <br />Contrad Price of Work <br />� h U1lC � C'i �[�''' � <br />Contad Person (Plan Review) <br />th�s opplrcafion and know fhe same fo be frue antl <br />goveming lhis type ol work �vill be complefed � <br />�l e pemnf dces nofp iesume fo give ou(honty to <br />de ur loca/law rngulalrng consfrucfion or fhe <br />FEE <br />� (he /`�G�Z _�29 <br />Yand <br />\- <br />Phone <br />Phone <br />Phone <br />