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ELECTRI�CAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMiT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —v✓ww•everettwa.org � `�`�3 <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � ,3D1,�aY <br /> -:�'�"'�� c� ,��-��icJ� c;-�,/1-` <br /> PROJECT ADDRESS � <br /> .>Ur' ` .��e��- � .5 ,� l� ���e,.o•i t� �,$'i�.3 <br /> Owner <br /> MailAddress Cily State/Zip Phone <br /> Tenant <br /> MailAddress City State2ip Phone <br /> -T i - if S /�� o c�T ..��1- �b'J�,� �(151SSS�}i <br /> !�� 'o � ��'=t�� � �-�[l �.� � Phone <br /> C-IeclricalCon�ractor MailAddress City StateR�p <br /> � u��G <br /> !�•5� 5�.��U•'Z L�l Contract Price of Work <br /> Stale License Number <br /> i)_ � , — <br /> Proposed Use of Building Contact Person (Plan Review) <br /> ,�cw <br /> Square Footage Qf residenlial new construction,remodel or addition) <br /> � ,_t . f <br /> Description of Work to Be Done: ✓'E= � � 'c' " '`'t � ' �` � `+ <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. Q/'\� <br /> ���) <br /> CITY O� l�VERETT LOCAL SALES TAX CODE IS 3105 <br /> � <br /> 1 herehy cei+ily that 1 have read and examined fhis app�ication and know(he same fo be tn�e and ` <br /> correct All pmv�sions ollaivs and ordmances goveminy this type o/work wiU be comp/eted <br /> �C- �� � -OZ <br /> �vhefherspecificd herem ornoL The granting o/a permd does nof presume to givo aufhonly to <br /> violale orcani el the provisions o(any otherstate orlocal law mgulating const�vc6on or tJre <br /> performance�JconstrucGon. Thaf I am aufhonzed by lhe ownerollhis piope�ly tn per/orm fhe <br /> work for which applicafion rs made and 1 comply wifh the Stafe Confractors Law 1827 RCW and <br /> 296.200 WAC. <br /> I � � <br /> � � . =c�-.J ,� � % - % - _ `-Y �' <br /> Signature �/ Dala <br />