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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, tVERETT, 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 /> �� �j i / �lc: .f �-1 fw �o ,.�. <br /> � <br /> PROJECTADDRESS <br /> ��i , .. /u� ' �/. . , i. .'"C�i/�� ��r �.� /:�� �;r'!� 6✓l1 �7 .J.JL�! �� S�'. ��F} � <br /> r. <br /> Ownef Mail Address City Sta;e!ZIp Phone <br /> Tenanl Mad Aadress Cily StatclZip Phone <br /> �i"✓'�.I_S � � . / �-I' �ii I� J�G'J°. � �/�7 /'Jj �:,ti �•-� l.L'� `/J7J3 ��lJ "��J <br /> • � • —� <br /> Electrical ContraclOrv Mail Address` Cily State/Zip Phone <br /> ,� '/,' C L �� �= J� � ` ! ,� <br /> State License Number Contract Price of Work <br /> _� / % <br /> Proposed Uso of Buildiny Contact �erson (Plan Review) <br /> � � , <br /> Description o(Work to Be Done: �'r� ' !� � � • � �'� J � 'V'—� -> %<� ^ , �� � '��— <br /> �) . , �./ <br /> �i r t� !.. (: � . ,. . ! � t / l: � � r�-i��� /�%C �C_ <br /> NOTE: WIRING IN NON-DWELLI�JGS IS REGUIRED TO FEE -� <br /> , BE IN RACE�^.'�;YS, A9C OR AC CABLE. <br /> � j <br /> � CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 <br /> � !herebc r,eml;thaf' h��c ra.�d and exammed:his application and know fhe same to be true and <br /> , ,:oner.( All prcwsmris �i'a�ti�s and��rduiances goveining this type ol work ��vill be[omplefed <br /> �� �vhefher speaiied nere�n a�nct The granfing or a permd does not presumr to g�ve aufhnnty fo � <br /> �, �nelate or cance/fhe prowsiens ol any other state or local law reguiafing constructiun or the <br /> 'i periormance ol consVur�ion. 1'hat i am authonzed by fhe owner ol th�s property to peAorm the <br /> �� �.vr..rk lor wh�ch app6catien is made ard I ccmply wrth the S;ate Contractors Law 18.27 RCW and <br /> � ��s z�o wA�. � 6� ' <br /> _ , _ (S� � <br /> � ':,�;. .- , ,�1 .- - � �� �`., - , <br /> S:gnat�re Dale � <br /> /�U <br /> ! <br />