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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX425-25�-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FRGM 8 AM TO 4 PM <br /> � <br /> �--3 i 7 r u ��roy1 <br /> PROJECT ADDRESS <br /> j;,=/�i�; t ��''� �"�1 5� ,:;'e <br /> O�vner Mail Address Ciy- StatelZip Pnone <br /> Tenant Nail Address Cily State/Zip Phone <br /> 7 . _ <br /> If i�C� '� G�%f�'4�I PIPCi,1%( 9 �>'/ '3; ��,zu�� sF �'l<«<'T /l/�� �IP:D�' <br /> Eleclrical CoNracto� Mail Address City State/Zip Phone <br /> Slate License Number Contracl Price of Work <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Description of Work lo Be Done: ��/� l�� � �� ��/�/ll"1Q� �,�'j `� �(���/,'� �qr71Q - <br /> , � <br /> NOTE: WIRING IN NON-DWELLINGS IS R[QUIRED TO FEE <br /> BE IN R,4CEWAYS, MC OR AC CABLE. <br /> i <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceRily fhat 1 have read and exarnined fhis applicalion and Icno�r fhe same!o be frue and <br /> ccrrecf. All provis;ons olla�vs and ordinances�overnma fh�s type ol�rork will be completed <br /> �vhether speci6ed herein or not The granfing o/a permd does not presume fo give aufhanty to <br /> violate or cancel fhe Provisions o!any o0�er sfate or local law regulafing con;tn�cbon or the <br /> p�rformance o/consf�uction. That 1 am authorized by the owner ol fhis property to perlorm the <br /> work/or which application is made and 1 comply�aith the Stafe Con6acfors Law 18.27 RClNand <br /> 296.200 WAC. <br /> : � ,- �� . � i• <br /> ,�� :c �,;,� �!' �e-� C <br /> Signatu e Date� <br /> Cv� lo iZ� <br />