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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.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />!. !> `) F f`�L- <-1-i �� T <br />PROJECTADDRESS <br />«i rJ i�� i C� Jo�1 �J �f� � -- <br />Owne� MailAddress Cdy StalelZip Phone <br />Tenant <br />Ma�lAddress <br />Gty <br />Statel7ip Phona <br />n <br />�pn(r,li �l F� T��� (,2n� "LbiST Sr N�� 57l�,�woeD �1A i�2 1 L <br />ElectricalContractor MailAddress CAy Slaie2ip y�"t jc��PJ�)5� <br />) <br />»rnrr,�Cl �ook�- <br />Slate License Nv�nber <br />�r i- <br />f'ioposed Use of Duilding <br />Square Footago (If residential nevi conslruction, remodel or addition) <br />�() <br />Conlrect Price of Work <br />Contact Person (Plan Review) <br />Description of Work lo Oe �one: �.Ji � N�I.i j'v���l �J/�l 1}ciu �[71�5�,�,1�/ {-{F�A� <br />NOTE WIRING IN NON-�WELLINGS IS REQUIRFD TO <br />BE IN RACEWAYS, MC OR AC CAOI.E. <br />CITY OF EVERETT LOCAL SALE5 TAX CODF IS 3105 <br />I hweby certdy Ilraf I hav� mad anJ exmnined (his epplicntion m!d know the sanro la bv fruo and <br />conecL All piovis�ons olla�vs and urdinancr,s govemmg (h�s type o/ �.ork u�dl be cumpleted <br />�vhetherspecilied he�ein ornuf. 71�o gianfing o/a pennd does nuf iesurno fo givo au(honty fo <br />vio/afo orcancel fhe mvisions o/any ofhei s(�to or/ocal/av� �eguPfing construchon or fho <br />peilormance o/cons�iucfion. That ( am �uBionzed by fho ou•ner ollhis� roperty fo peAorm �ho <br />�rc�k for �vhich application is rnado and I comply wifh flro Stafa Conf�aclors Lew 18.27 RCW nnd <br />296.200 WAC. <br />! 1 �_ � 1 i_ <br />---�—�– — - u:;��� . _. _ _ - - <br />,,�un ture <br />FEE <br />���� <br />�IZII-Ib5 <br />