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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-267-8810 - FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />6//S E�ST D�UE <br />PROJECT ADDRESS <br />MY��lf� YLD �r/OT� :±�/SEQ,P �/i��ETi Gl�i¢ 9�'103 YZS3Sb3s8� <br />Owner Mai� Addross Ciry State2lp Phone <br />Tenant <br />Eleclrical Contraclor <br />Stale Licenso Number <br />Gi /i%NG .¢+QF_ � <br />Proposed Uso of Building <br />Descripllon of Work to Do Dono: <br />Mail Address <br />Mail Address <br />Cily <br />Cily <br />Stale2ip <br />State/Zip <br />Conlract Price of Work <br />Conlacl Person (Plan Raview) <br />Phone <br />Phone <br />NOTE: bVIRING 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 <br />1 here6y certify If�af 1 have read and t:xarnined this application und kno�v fhe same to bo fruo and <br />correct. All piavisiau ollaws and o�dinances goveming this type of work �tiill bo comple(ed <br />�vhether spe.,i6ed herein or noL Tl�e granting of a pernut does nof �resume to give authonty to <br />violate or cancel the provisions of any other sfate or local la�v ree�ulatinc� construc6on or tho <br />perfomiance o! conslniction. That I am aufhenzed by the otvner o/ fhis properiy to pedorm the <br />work for �vhich application is mado and 1 cornpl}� wifh Ihe Stato Confracfors La�v 18.27 RCW and _ oO� <br />296.200 WAC. / � <br />��ID <br />, )�,�-�_�_ - 0617�/ r-' <br />... ...___ 9 n��e <br />