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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everetlwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />� I �,•� r I�� I��..,,�� --��.��i� �L%c�, �/r'�c-� <br />PROJECT ADDRESS �l <br />F �f <br />Owner <br />Tenanl <br />Mail Addross <br />Mail Address <br />Cily <br />Cily <br />✓ <br />r�`. � � � <br />I�� l_ � <br />Slate/Zip Phono <br />Stale2ip Phone <br />� c ' . 1 i!,'�'r• ��'i . .-� (-� �i �t' fili` .:: �'.:'� �_ ,/� _��'_�%�� i::•'7 <br />,i� �i�lAf� /�ir�'�i_��. . <br />Elecl�iCal ConlfaClof Mail Address Cily State2ip Phone <br />lilC�nr' I_�%��� i ,l <br />Slato Ucense Number <br />Proposrd Usc o( Building <br />Descriplian of Work to Oe Dono: <br />NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO <br />BE IN RACEWAYS, MC OR AC CABLE. <br />CITY Of EVEREiT LOCAL SALES TAX CODE IS 3105 <br />c�� �3- <br />Contracl Prico of Work <br />Contact Person (Plan Reviow) <br />1 hereGy certily Ihat I have �ead nnd exnmined this applicafian anJ knou� Ihe samo fo be Uuo nnd <br />correct. All prowsicns o(la�vs and ordinances �overmn� fhis type of aork will be completed <br />�tiliether specilin.d herein or noL Tho �ranfing ol a pennd does nof veswne fo give aulhonty fo <br />violate or c<vicel fhe provisions olany other sfate or Iecnl la�v rec�ulating cans(ruction or the <br />performance o/construcfion. Thaf 1 am aufhorize�i Gy fhe owner o/ this propedy fo perfomi Iho <br />work /or �vhich application is m�oo and I comply nafh fhe Slate Con6actors Leiv 18.27 RClNand <br />296.200 WAC. <br />( C ' . .- � �. <br />_ �� � <br />� '�Signature - � Date <br />FEE <br />+J vl� i21 <br />