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ELECTRICAL P'�RMIT APPLIC�TION <br /> CITY OF EVERETT PERMI7 SEI�uICES � ` � o _v � <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 -v�tiv�•✓.everettwa.org L p g(� �/-/ <br /> APPI_ICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> �1�� ' �> ��:V � (/ � —7/ —�; <br /> PROJECT ADDRESS ` /��/`/� �C .%) <br /> Owner P.1ail Address Cily SIa�e2ip f'�����^ <br /> Tenant Mai;Address Cily SlalelZip Phone <br /> E-lectrical Conlractor Mali Address C�ty Stat�<�7m 1'no�e <br /> Slale License Number Conlracl Price of Wor1: <br /> Proposed Use of Buildin� Conlact Person (Plan Review) <br /> Description o(Work lo Be Done: �!,'�i// j/i' ��'"���� <br /> ✓ <br /> NOl'E: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> B[ IN RACEWAti'S, MC OR AC CABLE. <br /> I <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 �L�SL4 , I�z, <br /> I hcreby r,erti/y that 1 have read and exarnined this application�ind kno�r the sarne fo be tr�:��and L <br /> conect All provisions ollaws and ordinances yovermn�fhis fype o/�rork will Ue cenrpleted <br /> whother specitied herein or nnL The grantin�o!a pemut docs not�resume lo give authonfy to <br /> violafe or cancel lhe provisions ol an}�o(her sfafe or local ia�r regu afinc�crnsfrucfion or Ihe <br /> perforrnance o!consVucfion. Thaf 1 am aufhorized by Ihe owne�o/this property to perlorm thc <br /> work lor which application is ntado and 1 comply�ti�ilh the Stale Confractors Law 1027 RCW and <br /> 296.200 WAC. <br /> j . �ir/� f� G�,����/ �l l <br /> _� � <br /> 8ignalure ���� � � <br /> II <br />