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ELECTRICAL PERMIT AF�PLICATION <br />CITY OF EVERETT PEE2MIT 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 TQ 4 PM - UEBIT 8 CkED1T C4RDS ARE NOi ACCEPTED <br />� � <br />��'I � h� I v.��. ��f� �° � <br />FROJECT ADDRESS <br />��_(C< ; <br />Owner <br />Tenant <br />Electrical Contractor <br />� <br />, � r ��, /c�i.�r � 5 ,�-��. s � <br />tdml ACdrecs <br />State License Number <br />Propased Use of Euilding <br />M1fail AtlOiess <br />M11ail Address <br />Desaription of Wcrk to Be Done: '�_ o c C> <br />NOTE. WIRI.VG IN NON-DWEI_LINGS IS REQUIRED TO <br />BE iU RACEV�AYS, h1C OR NC CABLE. <br />L c.- <br />C p- <br />City '— <br />Ciry <br />�'�'C9 �t��'G'�� <br />SIaINZq; <br />Slate�Zip <br />Slate/7_io <br />Contrect Price of Work <br />Contact Person (Plan Review) <br />FEE <br />CITY OF EVERETT LOCAL SALES TAX CODE IS �105 <br />I hereby cert.J� Ihaf I haoe read antl exammeU fh�s apprcarion and knc;v fhe same 'o be true and <br />correct. Anprcwsior.s o/laws and ordu�anr,es go�em,n� tha type ol work wdl6e compieted .. <br />aneLher specdied nerem or nct. Lie 9ran;�ny o/ a permd Joes nof presume to g�ve authonty to <br />nclate or cancel the prousions o! any o(her,tafe cr Iccal law ie,rWatiny conslrucLen or the � � �� /� �7 /��� <br />perfermance o� c�nstrucfion. rhaf I am au7honzed by fhe owner ol this property to perlorm fhe �� ZiL, <br />wc�k lor which app�icat�on is made and I comply w.dn the 5(ate Centractors Law 1 A.27 RCW and I�'�� ' � <br />°tio.200 WAC. . � <br />� <br />\ <br />.� � � � � �� � �� �� ��� 7 �� � � �� � � <br />d,;.,�-i..:c �. ! Cato <br />( ,:I /( - � l2 i <br />Phcne <br />Phone <br />Phone <br />