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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 - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> ��S ?;r1�'.�R, �i'V� <br /> PROJECT ADDRESS <br /> tiZ5 <br /> rx�2so u� �f��� c�u�r4�/�- t� � G,, q , �3 - i y e <br /> A /�c �I <br /> Ownef Mail Address City State/Zip Phone <br /> T�}��� <br /> Tenant Mail Address Clty Slale2ip Phone <br /> �w/G'�-- <br /> Eleclrical Contractor Mail AdOress Ciry Slale/Zip Phone <br /> N./� , <br /> Staro License Number Contract Pnce of Work <br /> Sc-�4c� FAyn/t y v�`� OGcJ�Snc-l11� <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Descriptlon of Work to Be Done: �DD Gf-c ! l�('� c/iT" �-s/L i�yv �4�'�j/1oo/s, <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> EE IN R.4CEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certily thrf I hace�ead and examined fhis epphcaticn and know the same to be true and <br /> correct. All piovisions o!laws and o�dinances goveming this fype ol work will be comp/eted <br /> whefher specJied herem or nof. 1'he granhng ol a permrt does notp resume fo give authonry to <br /> v�o/afe or cancel 1he provis�ons ol any ofher sfate or local law regu/ating construcfion or fhe <br /> peAormance ol construction That/am euthonzed by the owner ol this property fo peAorm the <br /> work lor which application is made and/comply wdh the Sfate Contractors Law 78.27 RCW and <br /> 296.200 WAC. <br /> ` �p �y^. D�f <br /> Signature Date <br /> � � ��(LB �� <br />