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ELECTl�lCAL PERMIT APPLIGATION <br />CITY OF EVERETT PERMIT SERVlCES <br />3200 CEDAR STR[ET, EVERETT, WA 982Q1 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />�t z5� '33a - y,oaZ <br />1C713 F=C-EMl/�rG Si r-vFt2.C1T� �.J(� ��z-�3 <br />PROJECT ADDRESS <br />F1-�2t= �+N �e� ���r, r.�. �� � I 3 F(-Eht I N G S 1 � �P�Y�e� Vt/ (� �18 2,�3 <br />Owne� Alail Atldress City Slate2ip Phone <br />Tenant <br />Electrical Conlreclor <br />State License Number <br />Proposed Use o( 8uilding <br />A1ail Address <br />Atail Address <br />Description of Work to Be Done: __ ��f"L <br />NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO <br />BE IN RACEWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE �S 3105 <br />Cily <br />City <br />State/Zip <br />StatelZip <br />Conlracl Price of Work <br />Contacl Person (Plan Review) <br />I here6y certily that I have read and examined this application and know the same to be true and <br />con�ect. All provisions o(laws and ordinanc2s govrr.vn_q fhis type o/ work will be completed <br />whether speci6ed herein or noL The granting ol a permd does not presume to give aufhonty to <br />violate or cancel fhe provisions ol any other state or local law regulating construcfion or fhe <br />per/onnance ol construcGon. That 1 am aulhorized by fhe owner of this propeRy to peAorm the <br />�vork /o� which app/ication is made and I comply with Ihe State Contractors Law 18.27 RCW and <br />296.200 WAC. � <br />7// �/0 7 <br />FEE <br />F C�C�� ���1 <br />Pnone <br />Phone <br />