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/ � <br /> � <br /> ELECTRICAL PERIInIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT. WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —�vww.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROfA 8 AM TO 4 PM <br /> �'7 �l �[/.���r�i')PP:1/ <br /> PROJECTADDRESS ;� <br /> (/ <br /> Ownef Mail Addre:s Ciry StatelZip Phone <br /> /l � <br /> � ,f� . ;/ �' ��:�2,t <br /> Tenant � � Mail Address Cily Stafe2ip Phone <br /> Eleclrical CoNractor Mail Address City . StatelZip Phone <br /> Slale License Number Contract Price of Work <br /> Proposed Use of Building Contacl Person (Plan Review) <br /> Description of Work to 6o Done: / f� ������1 ���—Y%1��� �� <br /> J <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 � O�D� ' ��� <br /> I hereby certify(hat 1 have read and examined fhis application and know(he same to be true and <br /> correct All provisions ollaws and ordinances govemmg this fype o(work will be completed <br /> whether speafied herein or noL The granting o/a pennd does not resume to give aulhonty to <br /> vio/ate or cancel the provisions o(any ofher stafe orloeal law re�uPting construclion or(he <br /> pedormance o(consfrucfioa That I am aufhoriz?d by the owner oRhis property fo pedorm fhe <br /> work lor which application is made and 1 con�ply wi(h the Sfate Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> � /�/� 9 <br /> SignaWre Dale ' <br />