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EL�CTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.evereltwa.org <br />APPLICATIONS ARE ACCEP7ED FROM 8 AM TO 4 PM - DE81T & CREDIT CARDS ARE NOT ACCEPTED <br />L'�''G <br />— J � � C:. ' � �'liC: c' � � <br />PROJECT ADDRESS <br />Tenant <br />Eleclrical Contraclor <br />Slale Licens: Numbcr <br />��- � I Z <br />Proposed Us e o( Buildin� <br />Descriplion uf Work lo Be Done: <br />M 1'> r � _ <br />M11ail Address I l. <br />Mail Address <br />Mail Addmss <br />JC: nl S City �, J� ci � � � v SlatelZip <br />NOTE: WI�ING IN NON-DWELLINGS IS REQUIRED TO <br />3E IN RACEWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />City <br />City <br />M, <br />SlatelZip <br />SlalelZip <br />Contract Prico of Work <br />Conlact Person (Plan Review) <br />FEE <br />I IIP./C�j� CE'�41/y II7.7i I I17VC /Cdll end eramined (his applicafion and know fhe same fo be true and <br />r.orrecL All �..-ovisions o/ laws and ordinances govemmg ffus fype ol work will be completed <br />whelher spe.ilied i;arein or noL The pranting o/a permrt does no( resun�e lo �ive authority fo <br />viola(e or cancel fhe provisions ol an}� oNier slate orlocal /aw re�uPfinr� conshuction or fhe <br />perlormance olconsfmcfion. Thaf 1 am aulharimd by Ihe owner ol (his property to perlonn fhe <br />�vork lor whi�:h npplia��f.on is n�-�de and I compty �vifh the Stafo Confractors Law 18.27 RCW and <br />296.200 bVAC. <br />tc�5G7-I�lo <br />Phone <br />Phone <br />Phone <br />