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E�.ECTR�CAL 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 />APPLICR�TION:i ARE ACCEPTEII FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTEC <br />`��'�' S� ���=�'ri7 i�->�LL �•✓/dy <br />PROJECTADDRESS <br />1L_'yA�t1R:� ��C'�, S2: v�-�f—?�r7T%/Yl%�L� L ��r'�% <br />Owner Mail Addiess <br />City <br />Tenant <br />Mail Atldress <br />�4�..SL ��/�C�'X �.��C 7U <br />Contractor MailAddress <br />�'C�'[� Lt �' G� ��/�D �� <br />State License Number <br />�/=r/ �=� <br />Proposed Use of 9uilding <br />Description of Work to Be Done: <br />7L' i LL ,Y <br />NOTE: WIRING IN NOfJ-DWELLINGS IS REQUIRED TO <br />BE IN RACEVv4YS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />City <br />City <br />T �-� <br />SIaL/Zip <br />State/Zip <br />'J�:�c'`��'� <br />; �hone <br />Phone <br />E• <br />/✓,/� �/l�I�C- ��Y�i- -[�'CG��.� Y <br />Sla�e/Zip <br />Phone <br />�� <br />ConTrect Price of Work <br />i�1_�r'_r i/ i%�.�'7"�c:�/ <br />Contact Person (Plan Review) <br />I herehy certi(y t,hat I have �ead and examined lhis applica(ion anr' know fhe same to be true and <br />correct. All provrsions of laws and ordinances govem�ng (his type of work will be comp/efed <br />whethar speci6ed herein or noL The gran(iny oi a pennrt does nol presume lo give aulhonty to <br />�eKon; anc ofc nsPuction n7hat I am�autlio ized by tlie�o v e9of tf / s propeny to pe�orm the <br />work !or vvhich, applicafion �s made and I compl}• wi(h tho S(ate Contractors Law 12.27 RCW and <br />236.200 W.4C. <br />�•� <br />r � <br />� � }C <br />FEE <br />� GSD!-! �-S <br />