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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREFT. EVERETT, WA 98201 <br />425-257-Sfi10 - FAX 425-i57-8857 - www.everettwa org <br />APPLICATIONS ARE ACCEFTED FROM 8 AM TO 4 PM <br />�_� � ( �-f� I��.-�-i�� l�� v� _ <br />PROJECT ADDRESS <br />�`�1� �l �.� r <br />Owner <br />Tenant <br />�,< <. l �,,•, � <br />E�eclrical Conlrar,lnr <br />Mail AAdress <br />Mail Address <br />�! <br />M.ul AAdress <br />� <br />�- Cti�� `»�' ��7 ��(.� <br />State License Number <br />��,.� �, � <br />Proposed Usa ot �uddnul <br />D�!scrip�ion al Wurk lo Dc Duno� _�� <br />�JOTE WIRING IN NON-DV1'ELLINGS IS RE�UIRED TO <br />BE IN RAC[WAYS, R1C OR AC CABLE <br />CITY OF EVERETT LOCAI SALES TAX CODE IS J105 <br />Sb.�C— ��-- <br />Gly SIa1�2ip <br />C iy Statc/Zip <br />l�,/ �w 1,�,+<} ¢�d'�S <br />Cdy \ � SlaleQip <br />lo d <br />�� <br />� Coniracl Price ol Work <br />��av, �,R,�.i���� �l � <br />Phonc <br />Phone <br />I Y�sl ti�,Q h�;� � <br />Phone I <br />Cont�ct Person (Plan Revmw) <br />I he�ubp �:erUly fhat I havu �c��J and rrumrned fhis appl�c��hon am' hn.ne fhn s+uno to be fnir and <br />���nrr,! All pr�rv�sinns ullnws nnA oidmancas i7ovemrn� Ihis �ype ol �tuiH will be compleleJ <br />,�h�rfher sprcdieAherein or qof. The _quintinc7 0! a perrnd Jnes nof /uesunw fo c�ive aufhouf}� to <br />nolede or cancel fhe `novisions ol eny other sfafe or local law rnr�ul.�fin� consVucGon or the <br />�u�i(o�mance ol constiurrion T�af I am aufhoiized by the owner ol fhis p�opariy to peifonn the <br />it��ik lor which��ppllc,�fi�7n is n�de anAl comply wrth fhe Sfafe Contracfors Law 18.27 RCW and <br />7,+ti 2���AC. V ` I i <br />I �� \' �' -- ._��' - / `%"C��� <br />.i i..�_ ; _ _ _ - <br />r ..,� .,au,. � ` n:i�c <br />i-EE <br />� �,Y�,rj� - U� 3 <br />