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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES o� `p6 <br />3200 CEDAR STREET, EVERETT, WA 98201 S' <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org � 0(d �A�� <br />;. <br />PROJECT ADDRESS <br />��- � <br />� <br />owncr <br />Tenant <br />i � _� <br />Eleclrical Conlraclor <br />Slale License Number <br />Praposed Use o( Building <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />�. <br />;<< , <br />1,1ai1 Addrr,ss <br />i�idll iid(�fC55 <br />Mail Address <br />Descriptlun of Work to �e Dona �' i��� ;� l �ti' <br />i <br />NOTE: WIRING IN NON-DWELLINGS iS REQUIRED TO <br />B[ IN RACEWAYS, MC OR AC CABLE. <br />City <br />Cily <br />. � � ,� > _ <br />;,��, � �'C � � �� � jC�:S t'�,. <br />State/Zip Phone <br />State2ip Phone <br />S�ale/Zip <br />Contract Price of Work <br />Conlact Person (Plan Review) <br />FEE <br />CITY OF E'�ERETT LOCAL SALES TAX CGDE IS 3105 <br />I hereby cerlP� Ihal 1 have read and examined Ihis application and know the same fo be hue nnd <br />conecf All pr�: �sions ol Imvs and ordinances governmg fhis type ol �aark will be complefed <br />wheffter 5peci6eAhe�tin or nnL The g�<�nfing ola perrnd does nof resume ro give authority fo <br />violate or cancel lhe p�ovisions o/ any other s!ato or local la�v rer�uPfin9 const�uction or the <br />perlorniance olconstruction. That I am authorized G}� fhe o�rner ol this p�operty to per)orm Ihe <br />wo�k l0/ �vhich eppliCati0rl is �nBde and I COO7ply u'ifh thi? Sfafe Cenf�acfors Law 18.27 RCW and <br />29�.200 WAC. <br />,, , , <br />Si�n�ture � Date <br />�� � �; <br />� �� ,� <br />F'hone <br />