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( <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVER�TT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8B10 - FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM -DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> �`I � �r .�, �< <, ,�J �J� <br /> PROJECTADDRESS <br /> l'�� I�c<«� b'� I�a�� Iy E '<< � ,,,�� R� 'l� C✓rr�'�1 l�,< <dzv�/ <br /> Owner Mad Atldross Clty Slale/Zip Phone <br /> � � � , ( , �'� ut� C✓�'c� tf l�J , y� �'l '��' . , <br /> �rli� S��r. ��, ��.ea� S��t� !y � �u� ��� , � � a'. s,� �3z�' <br /> Tr.nanl MalAdtl�oss Cily Stale/Zlp Phone <br /> /� <br /> EIeCIriCalConlraClOr MailAddross City Slale/Zip Phane <br /> / <br /> State License Number Conlrecl Price ol Work <br /> �� l �r' (`r <br /> Proposed Use ot�uilding Conlacl Person (Plan Review) <br /> Descriplion of Work lo Be Done�, � ' ` � ) ��� V�'�(-.� ��� ��L- �`��� ��1� S -��'r �1/ � `� <br /> —T <br /> �- ( �( ii (v � i �� � ��� �,li� �. <br /> NOTE. WIRING IN NON-DWELLINGS IS REOUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS�105 <br /> I hereGy certity fhaf I have reaA and oxnmined flris apphcaGon anA hnow!ho same fo be hue and <br /> conecl. All provrsions ollaws and orAinances governmg Nris fype ol work will bo complefod <br /> whclher spealieA hern�n or not. The granfing o!a permd does nof >resurno fo givo aufho�ity fo <br /> violafe or canccl the provisrons o(any ofhor sL�le or local law re9ul�ting construclion or Uio <br /> performance ol consln�c6on That 1 am eufhorized by INe owner o�Ihis property lo perlorm fho <br /> work!or which applicalion is made and 1 comply wifh fhe Stafe Confraclors Lnw 18.27 RCW and <br /> 296200 WAC. <br /> �, t �,. ; � � .�� � ��iivSl,\– I� IZ���`� �`"I <br /> � Signaiure Dnle ,I � � I � <br /> � /� I <br /> . I <br /> l / <br />