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ELECTRICAL PERMIT APPLI�ATION <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 ACCEPTED FROM 8 AM TO 4 PM <br />� ^� '! s l�< Pr'��� �.�- <br />PROJECT ADDRESS <br />Owner <br />TenaN <br />�, `. � <br />r��l(�, ���� �_ �R - <br />61ai1 Address <br />Mail Address <br />�-1 �� k� -/� i�, 6'r �; . �, �%1 t <br />Contraclor Mail Address <br />`�i � i -� <br />�Lr� ��?�_l_ ��S IZl_1 <br />Stalo Licenso Numbcr <br />� <br />,� lr �•i �� � �vL i <br />Proposed Uso ol Building <br />DoScriplion of Work lo Be Dona <br />NOTL: WIRING IN NON-DWFLLINGS IS RE�UIRED TO <br />DE IN RACEWAYS, MC OR AC CA�LE. <br />Cily <br />Cily <br />C�ry <br />� <br />����� CI(.� �•� � �.��, <br />LC <br />Slate/Zip <br />Slale/Zip <br />� �1��� � �3��- <br />State2ip <br />Conlract Prico of Work <br />Conlact Person (Plan Reviaw) <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 herety r,e�Uty fhaf I havc read nnAcxmnined fhis application anA6now Ihe same to Ge fruo und <br />conect Al/ piovisinns ollnws anAordinances �uvemin,q this typc ul wo�k will be cornplefed <br />whefha specilieA hereirt or not. The granfing ol a pernuf docs nof presume to give authority fo <br />violafe o� cancel the provisions ol any other stafe or local law re,qula�,n,q construction or the <br />perinrni��ice o/ construcfion. That I em aufhorized by fhe owner ol fhis property to perlonn tlm <br />work Ior �shich appGcafion is made and 1 comply wilh fhe Sfate Confracfors Law 18.27 RCW and <br />29G.200 W�.4C. <br />, <br />�a�. \� �-- I C: -�.C� -- Cl i c <br />FEE <br />Phone <br />Phonc <br />�� I <br />Phone <br />