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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.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM <br /> .� �. �- 1_ ll(+.'(�, l <br /> PROJECT ADDRESS <br /> •1 U. `>�:�h 11 ��1i ', ti`1�,� � 1;7,A��t . ��� l ��ii'c_, � l\�(� ;i�'��`S ��2�— �Il•�� <br /> Owner A1ail Address Cily State/Zip Phone <br /> Ten2n1 Mail Address Clly Slale2ip Phone <br /> — —_ _ .—_—.__._..._— ' _ _ <br /> ��Bf,lf'ICI11 (,OI1lf:lC101 Pdailll��d�etis fiD! St:11rQ�� �hppe <br /> Slale I_icrnso Nundioi Contrncl Pricoof Work <br /> Proposed Use ol�uilding Contacl Person ���lan Re�•iew) <br /> Dr,sr.ription ol Work�o�o Dona: _�—LM � ���' _ <br /> NOl L WIRING IN NON-DW[LLINGS IS REQUIRED TO PEC <br /> E3G IN RACFWAYS, A4C OR AC CA[3LE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hemby c��rtrly fhaf 1lia��e rcad end e+nrmned fhis applicnhon end knew fhe same fo be fnie and <br /> ronecf All prowsions o!/aws anA orAinnnces�ovaning fhis type ol work will be campleted <br /> whefhrr speci6ed hei�in nr nof. The pranfing ol n pennR does not �resume fu gi��e aufhonty to <br /> ��rolafr or r,encel Ibe tirovisiuns ul dny ofher state or loc�llpw re�u�etint�consfrucfion or fhe <br /> performnnce o!consliurtion. Thet A/il AU�IIOIIZE(�by�IIB OWIIAI 0I UIIS�110(lPl}y(J nB1I0I111(IIQ <br /> work lor whir,h eppdcriG �n is rnnde nd 1 cornpty wiCi fhe Stafe Cont�ecfors Lew 18.27 RCW end <br /> 29G.700 WAC. �. <br /> 1 �� ,,� <br /> � V 1 L � l�� <br /> \ \� ', <br /> --•� � � � <br /> Sig r Da e <br /> \` �� 1 f <br /> \_ J 1, <br />