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ELI�CTRICAL PERMIT APPLIC/�iION <br />CITY OF EVERETT PERM17 SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — ��vw.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />3i /�O l«eji/ /.'lL f-�l�'%'�'� <br />PROJECT ADDRES <br />„�,� ,D y <br />�i/ F�O� /-tr� <br />� lL'Ll�'e� ! �� r.i�: �c:!' �+, �'.`i.'� 3:�� S[� �P/( l��i+s-C G!�% �� i.. �i:ri'-:3t'.�e <br />Owner Mail P.ddress Ciry State2ip Phone <br />Tenanl <br />Eleclrical Contraclor <br />Slale License Number <br />Proposed Use of Buildin9 <br />Mail Address <br />Mail Address <br />City <br />City <br />State/Zip <br />State/Zip <br />Contract Price of Work <br />Conlacl Person (Plan Revietiv) <br />Phene <br />Phone <br />�. . <br />� <br />Descriplion of Work lo Oe Dono: �7�t���! '.� r'��5 s�u«�'J � c-c_/- �r�as� i!�'_ ir�'�-2�-•-�o r�s� v�Lt� <br />-• - � v <br />, <br />_ � - �J1•,.. - <br />NOTE: W IRItJG IN NON-DW ELLINGS IS REQUIRED TO <br />BE IN RACGWAYS, hiC OR AC CABLE. <br />CITY OF EV[RETT LOCAL SALES TAX CODE IS 3105 <br />�� �� ��U� �n�, <br />I hereby certify th,af I have rend nnd examined this application and kno�v the san fo <br />corroct. All pravisions ollaws and o�dinances governm� Ihis type of �rork will be corr�plefed <br />�rhelher spcaEed herein ornot. The c��anti�tg o/a parnuf does nof��resumo to give authority to <br />violatc or cancel fhe Fuovisions oI any other sfate er loc<al Inw regu.ating consf�uchon ar fhe <br />perlormance u/ constnicfion. Thaf 1 am aufhoiizad by fhe o�vner o/ this property fo pe�fonn Ihe <br />�rork lor �vhich applicafion is rn.:do and 1 corriply �riflr fhe Sfale Contractors Law 18.27 RCW and <br />296.200 WAC. <br />1�1��t�.1�% <br />FEE <br />