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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 Ct..�O —O � <br /> 425-257-8810 - FAX 425-257-8857 –www.everettwa.org C ��4,`1�/ <br /> b <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> ���12_ Lo � ����2 �� �: <br /> PROJECT AIJDRESS <br /> ���� c��� � ��,� � � << 2�<<c � z z99 <br /> OWnef Mail Address City State/Zip Phone <br /> Tenanl Mail Addiess Cily Sla�e/Zip Pkone <br /> (� C� ��I �`c���� /6�( /0 4S�c � L.�� �.� �, c'_—r 2.w p i.3� �'2 s�� <br /> Eleclrical Con�raclor Mail Address I-�ilx State2ip �one <br /> G� l{ � ��2 C Z�31 OI ( <br /> r� ;� �� � � �r � �a ��� ��I� 1 � �� — — <br /> Sfale License Number `' Conlracl Price of 4Vork <br /> L�`j <br /> Proposed Use of 6uildinc� Contact Person (Plan Review) <br /> Doscription of Work to Be Done: � � S � u� C� Z��� i'�� � �� l��� <.D o C <br /> I <br /> NOTE: WIRING IN NON-DW[LLINGS IS REQUIRED TO FEE � <br /> BE IN RACEWAYS, MC OR AC CAI3LE. <br /> � <br /> CITY OF EVERETT LOCAL SALES TAX COD[IS 3105 L1 ' '� � <br /> I hereby certi(y fhaf I have read and exarninud this ap/�/ication and kno�r the same fo be true and ��� 1 <br /> correcL All provisions o(laws and o�dinances goverrturg this type oI�t�ork will be completed <br /> whether specJied herein or not The granfing o(a parnut does not presunie fo give aufhoriry to <br /> violate or cance/the provisions o/any ofher stafe orlocal la�v re�ulatiny�onsfrucGon or the <br /> perlonnance o(construction. That I am aufhorized by fhe ownero(this property ro pe�form fhe <br /> work lor which application is made and 1 cornply with the State Contracters Law 782i RCW and <br /> 29G.200 WAC. <br /> ,-� �� , <br /> , <br /> , L <br /> ���._.,��_���_ `f — 3 � � _ <br /> S1gnaWra Date <br />