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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVEF.ETT, WA 98201 r�_ IS"v� <br /> 425-257-8810 - FAX 425-257-8857 -��v✓w.everettwa.org � 0������ <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> n � <br /> �c:�GZ� � �� L�% �� �e <br /> PROJECT ADDRESS <br /> ��r�iv�� ��� -c�'�P� s�� 2 �G7 �o�ay�� ���e�:��GUf1 .��2v <br /> O�vner ail Address City Slale/Zip Phone I <br /> � <br /> .�'O,c��G' .5 Z80.� C'�/ay /1�e ��i��i i Gv� .��ZO/ <br /> Tenant Mail Address � Ci�y S�ate2ip Phone <br /> Electrical Contractor Mail Address City Stale/Zip Phone <br /> Sta13 License Number Contract Price of Work <br /> Proposed Use of Building Conlacl Person (Plan Review) <br /> �) � <br /> Descnption of Work to Be Done: � (�Gf I �� / _5 <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 COUE IS 3105 ! 1 <br /> � r'7 <br /> 1 hereby certily fhal 1 have read and examined Ihis epplicalion and know the seme tu Le Irue and �V�t V � ���Y� <br /> conecL All provisions o/laws and ordinances governing this fype ol work�vill be comp/efed <br /> whe!her spealied heiein or noL The g�an(ing o(a pemid does not resume fo give au(hority to <br /> violafe or cancel the provisions olany olher sfafe orlocal law mguPeting constn�ctron orUie <br /> perfonnance o/construcfion. That 1 am aufhorized by the owner o/th�s propeRy fo perform fhe <br /> work Ior�vhich application is made and 1 comp��vith fhe Sfafe Confractors Law 78.27 RCW and <br /> 296200 WAC. /� <br /> / � <br /> � <br /> �'�,���'�,�, ��__ 1 U - �,S- v� <br /> Si�naWre � Datu <br />