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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.evereltwa.org <br />N �`�3 �� <br />� o$�y`�� v <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />PROJECT ADDRESS <br />,� <br />, � � ; :L„'li�� " 1 �(� , G =� <br />��`�1 i^ ��i';i' �'I�-;.� '�`• i� � i� � _ <br />Owner Mail Address City State/Zip Phone <br />n <br />.. r <br />Tenant <br />Mail Address <br />Cily <br />State2ip <br />Phone <br />� t l�j l L� ( � ) �'t'/ � "C /'i. j��L�7 � C,� (,�,i,r� �l (��,iL� J `�SS �C��L �( <br />l��t( <br />Electrical Conhaclor Mail Address Cily SlaleZp Phone <br />; - -, � � �' �� �- I G <br />^ - � �(� ��r � �r `�';':� � � <br />Stale License Number <br />�; �- - � > <br />Proposed Usc o( duilding <br />Descriplion of Work lo De Done: � <br />,� �. , , __ <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 IS 3105 <br />; � i 5 ��"�`' `5 <br />Conlract Price of Work <br />Conlacl Person (Plan Review) <br />I he�eby certi(y fhat I have read and examined fhis applicafion and know fhe same fo 6e true and <br />conecf. All provisions olla�vs and ordinances governing this lype o( work will be complefed <br />whefher speci�eAherein or noL The granfing o/a pernut does not resume to give aufhority fo <br />violafe or cancel fhe provisions o( miy ofher state erlocal law re�uPting construc6on or Ihe <br />peAormance o/ conslrucfion. That I am authonzad by fhe owner ol this property fo perlonn the <br />�vo�k lor which application is rnac'e and 1 comply wifh the Sfate Contracfors La�v 18.27 RCW and <br />296.200 WAC. <br />FEE <br />_ .�� , �, � �� <br />� 1 .O Y /l�_ <br />' � : � .r ; r � /� � � _�� ' l/ <br />-- � � "� —' Date 'J <br />^ Si�natufe <br />