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ELECTRICAL PERIV�IT APPLICATION <br />CITY OF EVERETT PERMIT SERyICES <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 />����� 1')C IvJ( �I(�<< �t`�� <br />PROJECT ADDRESS <br />� , <br />I(•I�.C'� !u:'�l�<��.��� ��II <br />Ownef ldail Address <br />Tenant <br />� l.� �( <br />Electrical Contractor <br />State License Number <br />Proposed Use of Building <br />Descriptian of Work lo Be Done: <br />Mail Atldress <br />Mail Ad^ress <br />� ��r i'� `�> r=� l��_� (�,� ��i <br />City <br />•��'� , „��. <br />NGTE WIRING IN NON-DWELLINGS IS RE4UIRED TO <br />BE IN RACE�.NAYS, MC OR AC CABLF.. <br />Ciry <br />City <br />�� '/Q'C�11 <br />5tata2ip <br />State/Zip <br />Slale/Zip <br />Contract Fnce al Work <br />Contact Person (Plan Rev�„w) <br />; CI7Y OF EVERETT LOCAL SALES TAX CODE IS J105 <br />� I hereby cert�ty fhat I hn�e read and examinetl fhis applicauon ar.d kmw fhe same to be true and <br />' correct. Al! prcvisions ollaw� and ordmances governmg fhis type e' work wdl be complefed <br />� �.vnether spea4ed herem or noL 7he giandng ol a Ferrnrt does not presume to give authonty fo <br />.: ;iolate a cance/ fhe prowsions ol anv olher sfafe or local law regu ating construcUon or the <br />, performance ol cor.struct�on Thaf I am aufhonzed by the uwne� cr th�s property to peAorm fhe <br />� ,vcrx Por which app6catrcn is made and ! comply wdh the Slate Ccntractors Law 78.27 RCW and <br />296.200 WAC. <br />r._ <br />re <br />/�'�/l/v <br />FEE <br />.� �y �a- �03 <br />�s� y�„sa <br />Phone <br />Phone <br />Phnne <br />