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<br /> ELECTR.ICAL 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 ACCEPTEG FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED
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<br /> PROJECT A�DRESS
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<br /> Owncr . Mail Address Ciry State/Zip Phone
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<br /> Tenant Mail Address � City Slate/Zip Phone
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<br /> Electrical Cont'ractor hlail Adaress Ciry State2ip Phone
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<br /> State License NumbAr Conlract Price of Work
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<br /> Proposed Use of Building Contact Person (Plan Re iv ew)
<br /> DescriptionofWorktoBeDone: I�'1',1,� �. ( � / rG(p�,� �„� f':�, .. : ,: Wql � $�v �, "f� �aCG�(r v�a I
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<br />� NOTE: WIRING IN NON-DWcLLI�VGS IS REQUIRED TO FEE
<br /> BE IN R,4CEWAYS, MC OR AC i:ABLE.
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<br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105
<br /> 1 here6y ceRify that 1 have read and examined this application and know the same to be true and
<br /> correct. Ail provisions o//aws and ordinances goveming this type o(work will be completed
<br /> �vhether specrlied herein or noL The gianling ol a pe�md does nof presume to give auG�ority ta
<br /> violate or c�nce/the provisions ol any other state or local law regu/ating construcnen or the
<br /> peAcrmance ef construdion. That/am authonzed by the owner of this property to perform the
<br /> �vork Ior whirh app�ication is made and I comply wdb the Stafe Contractors Law 18.2i RCW ano �
<br /> 296.200 V✓AC. /
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<br /> SiS�ature Oate �
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