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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 9&201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />y -a�-�5 <br />� � SO �i `-.i'y(� <br />APPLICATIONS ARE ACCEPTED FROM 8 AM f0 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />�J ��' n <br />, L�1�-� <br />— ��: -�� /� %�� �' �,' -�._ ' .. :rj �� , <br />' �.,1! - r.., . <br />PROJECT ADDRESS <br />OwnCf M11ail AdAress City <br />Tenant <br />Elec�rical Contraclor <br />Stale Lir,ense Num6or <br />MailAddress <br />Mnit AdAress <br />Proposed Use ol Building , <br />i <br />Description of Work lo Be Dunq�� �/� <br />NOTE' WIRING IN NON-DWELLINGS IS RE�UIRED TO <br />B[ IN RACEWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES 7AX CODE IS J105 <br />Cily <br />City <br />State�Zip <br />SlateiZip <br />Slate/Zip <br />Cunlracl Prico of Work <br />Contact Porson (Plan Review) <br />1 he�eby cr,r}dy Ihal 1 have IC8(I 7f7A �Xd/I11flCA iI115 t1�1�I1C8G011 and know fhe same to bo true nnd <br />conect. All p�ovisans o! laws anA oiAinances 9ovmning this type ol work will be cornpleted <br />�vhether speciheA he�cin or nol. The prantmg ol a pennd does not reswne fo give aufhority to <br />wolute or canc�l fhe prowsiuns oi any ofher sfafe or local law reguPfing consfrucfion or the <br />pedormance ol consfruc(ion. Thaf 1 anr authorized by fhe ewner ol fhis property to perlorm tho <br />�vork lor which applicahon is nmde anA I cornply wdh fhe State Contractors Law 18.27 RCW' and <br />29ti.200 WAC. <br />/� ! p ` <br />� „� <br />Si�nalure <br />FEE <br />Phone <br />Phono <br />Phone <br />