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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />4'L5-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CFcDIT CARDS ARE NOT ACCEPTED <br />�. r' r�/�7 <br />!1��C- (, ���i �����L)"il/�-f:.�l/ �Li <br />PROJECT ADDRESS <br />'1( <br />_� � l _ � � r� r"' � �-1 t� �f�cr ��-r.,; 5� I�1�1 3s >av � �; �G � c�� c� e� `r'�' �� ���� c-_ <br />Owner Mail Address City SlateQip Phone <br />Tenanl <br />Heclrical Contractor <br />Slata License Num6er <br />I��< <,. <br />Proposed Use o( �uilding <br />�.ted n�ldiesc <br />q!atl ndd,r�ss <br />Description o( Work to Gr. G�ma. __ _ �� i i L_ �_ _ j.� <br />NOTE: WIRING IN NON-DWELLINGS IS REUUIRED TO <br />B[ IN RACEWAYS, MC OR AC CA6LE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />Cdy <br />f,ily <br />Stale2ip <br />State'Zip <br />Conlracl Prico ef Work <br />l;ontad Pmson (Plan Rmlew) <br />1 hereby cerL(y Ihaf 1 h��v�� mad anJ ��r,vninod Ih�s apphca6nn nnd Fno�v fho sanre tn be frue anJ <br />correct. All provisions o! la�tis ;ind o�dm,mccs go��erning fhis type ol woik �sill be complefed <br />�vhefhor specilicd herom or nuf Thc ��ranhng ul n pernnt does nut�resunte to pive aufhonty fo <br />viulafc or cancol fhe provisions o( any ofher sfafe or lor.al law re9u afing consVdcGon or fhe <br />peifonnance o! consf�uctiun. That I am aulhonzed hy fhe owne� o! lhis property fo pe�fonn fhe <br />�vork lor whith application is m.�de and 1 r.omply �riU� fhe Sfafe Con6actors Law 1827 RCW and <br />296.200 WAC. <br />� �. <br />. t.. f � i�J`;�,1-� <br />� �) � <br />�X tJli _� <br />FEE <br />F �5c 7 r 3 7 <br />Pnono <br />Ph�ne <br />