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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERViCES <br />3200 CEDAR STREET, EVERETT, Wk 98201 <br />425-257-8810 - FAX 4 25-257-23 8 57 — wv✓w.evereltwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />!i�' I ��E��r � /I ����� <br />PROJECT ADDRESS <br />� Cil :! i t <br />owner <br />Mail Address <br />Clty <br />z1�-i,: <br />Phone <br />JaL;jt1'� �ZSLS�-�L)� <br />Tenanf Mail Address City Sfate/Zip Phone <br />� <br />��, �-�l w. � l��i���`- � � �� - � �-7 ����� �.� d,�Tye���,��L , <br />Eleclrical Conlractor Mail Address Ciry tatelZip Phone <br />Slate License Number <br />Ilc-� 5 1 �'.,�t� <br />Proposed Use of Building <br />Description of Work to Be Dune: <br />i /� <br />- [; �,.1 !�P i � <br />PJOTE: WIRING IN NON-DVJELLINGS IS REUUIRED TO <br />BE IN RACEWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />CoNract Price of Work <br />Contact Person (Plan Review) <br />I hereby certily fhaf I have read and eaamined fhis applicalion and know the same to be true and <br />correcL All provisiais o/ la�as and ordinarices governmg this type oI u�o�k �a�ill be completed <br />�rhefher speciGed herein or noL The g�anfing ol a permd does nof presume to give aufhority (o <br />violate or cancel fhe provisions olany other sfate or local law regulafing consfrucfion or the <br />peAormance oI conslruclion. That I am authorized by (he owner ol th�s �roperty fn pe�lonn fhe <br />�vork lor which application is made and 1 comply with the Sfafe Contractors Law 78.27 RCLI'and <br />29ti.200 WAG /1 <br />FEE <br />35,T�v <br />�OSd�•C�Sa. <br />:� <br />