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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.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> -� ��33 cNc �.�n�T 5T. <br /> PROJECT ADDRESS <br /> ��� IJW� <br /> Ownef Mall Address Ciry Slate/Zip Phone <br /> 7enanl Mail Address Cly Stale2lp Pho�e <br /> �umrY1 it� EGEv'���— �Zc,�j 'Z615T 5?' Nl� STAu�irx�0 wA ��iS2� 2- <br /> ElecWcal Conlraclor Mail Address Clty State2lp Phone <br /> y25 3o a S�S� <br /> �urn m �E � �O K�l- Wpc� <br /> State L cense Number Contrect Pdce of Work <br /> S r (� <br /> Proposed Use of Bullding Contacl Pereon (Plan Review) <br /> �escripUon of Work lo Be Done: ��J) M1-E 5 r I� <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE I <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> I.yereby certity fhat 1 hava read and examined this applicatlon and know fha same to be trua and <br /> correct All provis�ons ollaws and ordinances goveming fhis typa o/work will be complefed <br /> whether spaufied herem ar noL The grenting ol a permit daes nof resume to give authonty to <br /> vlolete or cancel the prowsions ol any other sfate or local law reguPfing consfrucfion or the <br /> peAormance ol consfrucfion. 7'hat I am authonzed by the owner ol this propaRy fo per/orm fhe <br /> work loi which applicnfion is made and I comply wifh the State Contractors Law 18.27 RCW and <br /> 296.200 WAG. <br /> � �--- - - I 1 do - 0`1 <br /> �. ._ <br /> Sig ature Dale <br /> .�C41d-05� <br />