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� <br /> 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 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> l� U ��� /��4�- �-1�✓r�rt+� J-i � �. <br /> PROJECT ADDRESS <br /> �'��G�vN ..���' ;-�Jr':.�i'.' �yr 7 �.��: ��ii,., a, J, : � �, C� ,`�, % � � <br /> c" <br /> Owner Mail Address Ciry State/Zip Phone <br /> Tenant MailAdd;ess City State/Zip Phone <br /> �/_.�:��"��' r��. . �.` L�Z 1 _������ 1 C� . ,l �yL-rC��.i"/) �_i.: ��. ��CCi� ���-J '�`!1 '`l'� <br /> Electrical Contrector Mail Address � City Slate2ip Phone <br /> <<',�'=��r �i r � ti` �� ����1,'. . <br /> Stale License Number Contract Price of Work <br /> �� �� t� ����� <br /> Proposed Use of Building Contact Person (Plan Review) <br /> _ ,� . ' , <br /> Description of Wark ta Be Qone: t �1 ,-�i� L c 5 L��L�,�� C Y�"' �L C r�, <br /> NOTE: WIRING IN NON-DWEI_LINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVEREiT LOCAL SAlES TAX CODE IS 3105 <br /> I hereby ceriify that I have read and examined this application and know the same to 6e frue and <br /> conect. All prcvisions of/aws and ordinances governing this type of work will be comp/eted <br /> �vhethe�specilied herein or not The granting of a permd does not presume to give authonty to <br /> violate or cancel the provisions o/any other state orlocalla�v regu/ating consVuction or the <br /> performance o(conswction. 7'hat I am authonzed by the owner ol th�s property to perform the <br /> work for which application is made and 1 ccmply with the State Contracrors Law 78.27 RCW and <br /> 296.200 WAC. <br /> � �'-�� � <br /> . � <br /> 'L �.�.�f�-.( .`"� r i —� i ._� J <br /> Signa re ' Date <br /> , � <br /> �.V5/ �)-� � l <br />