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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.evereltwa.org Q � �� `�Z <br /> � ��9- 0 �1 <br /> APPLICATION5 ARE ACCEPTED FROM 8 AM TO 4 PM <br /> /L��� U>13,r,�41✓: �/ <br /> PROJECT ADDRESS <br /> -, / <br /> l�:�ir� �<J,/�- �7�/� l�L /'•>>r�=l:�n ��l/1 r✓cY'l G✓ i��`1� <br /> Owne� MailAdtlress Ciry StatelZip Phone <br /> y1,(. �yYE' �y5i.3 <br /> /VG N/' <br /> Tenant A�ta�l Address Gty State2ip Phone <br /> (��l <br /> EleUrical CoNractor Ma�l Address Cily State/Zip Phone <br /> State License Number Conlract Price oi Work <br /> /1/c ,�(//= � S FQ� <br /> Proposed Use of Duildinc� Cantact Person (Plan Review) <br /> 9/� <br /> Square Foolage Q(residential new conslruction, remodel or addition) <br /> Description of Woik lo Be Done: ���-� !U W� __ <br /> / <br /> NOTE: WIRING IN NON-DWELLINGS IS R[QUIRED TO F�E <br /> F3[ IN RAC[WAYS, MC OR AC CADLE . <br /> CITY OF EVERET7 LOCAL SALES TAX CODE IS J705 <br /> 1 heieby r.erfily(hat I h��ve mad and exarnined fhis np�licalion and kno�v Ihr, same fo bc ln�e and G I ao(� '��� <br /> correc(. All provisicns olla�vs and ordinances govenunq fh�s type ol�vnrk will be complr.(eJ <br /> whcfhcr speci�r.d hcrcin ou�oL Thc grenfin9 0/a pemid does not �resume fo grve aufhority to <br /> viola(e o: cancel Ihe provisions o/any olher slafe orlocal law r�gu�ifing consfn�clion orlhe <br /> pe�fnnn��ncr, o/canslrucfion. That I�m aufhorized by If�e owner ol this �mperty(o pedorm!he <br /> wo�k(or�vhich applic.�iion is made and 1 cornply wifh fhe Stale Contr.�r.Iors Law 18.2!RCW and <br /> 296.200 WAC. <br /> —�� � ' �! <br /> ��J��=---- � /L/-/, <br /> ignaiwc Dalc <br />