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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� CREDIT CARDS ARE NOT ACCEPTED <br /> �= � �' -\ I�-{��f'�`� �.-f��l(�.. <br /> PROJECT ADDRESS <br /> a � i j'_I__r ;f— -- <br /> Ownef �,fail Addiess Gly Stale/Zip Phone <br /> TCnan� M11ad AdAress Gty S;ate2ip Phono <br /> ._��r��crli T E-Cr;i?'�� 1��,�'� ?���,r �T NW Si�1r�u��f� WA G�y 2�i Z y�S s�'� 5)5`I <br /> Eleclrical Conlraclor Mail Address Clly Slale2ip Phone <br /> ���m��ni�� ���� ��-"L �f ��,�� <br /> Stale License Numbor Conlract Price of Work <br /> �I� IL — — <br /> Proposed Use o(�uilding Conlact Person (Plan Review) <br /> DescriplionofWorkto8c�ono: LJI �`'� Al��•J �� � ��}� (�M� �,[-�-UiL �- <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE �N RACFWAYS, MC OR AC CABLE � <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby cerLty that I have read and exarnined this application and know fhe snnte fo be�t�ue and <br /> I conect. All p�ovisions ollaws and ordinances r�ovominp this type ol woik will Ge complefed <br /> �vhefhui spec�hed herein or noL The c�renlin,q oI a perrnrt does not �resurna fo givo aulhority fo <br /> i vn�late or cencel the provisions ol any olher sfafe or local law regulating consfrucfion or fhe <br /> 1 pnrforniance ol conshucfion. That I am aufhorized by fhe owner ol this property fo pe�fonn Ihe <br /> �vork!or which npplicafion is maAe and I comply wdlr Ihe Sfnfe Conf�acfors Law 18.27 HCW and <br /> 296.200 WAC. <br /> r <br /> l , <br /> � i / <br /> ___. ,:.. ���,�i�u,. ..____ . _ _—.___- ___--_-- Dalo <br /> C bSG�{-(�'J Z <br />