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ELECTRICAL PERMIT APPLIC�TION <br /> CiTY OF EVERETT PERMIT' SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 982G1 <br /> 425-257-8810 - FAX 425-257-8857 —www.evereltwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> � � �- 1 T�i 1 �IZ �. 1�\� � V �= 1r v 1 � <br /> PRGJECT ADDRESS <br /> 1:; �u�, ris� �,r_ �� ����' s� z � e � �� � —� Yi �'� <br /> Ownef Mail Address Ci�y StateiZip Phone <br /> Tenanl 67ai1 Atldress City State/_ip Phone <br /> J�.� � � � u �y i__�z.c�s tii � c � ��, � <br /> F_leclrical Coniractor Mail Address City StateiZ�p Phone <br /> (�'l� C� � �� /— C U � � �� '� _ <br /> State License Nmnber Contract Price of Work <br /> ,l }�.� <br /> Proposed Use of 6ulding Conl,act Person (Plan Revimv) <br /> Description o(Worh to f3e Done: }J 1- �V'���� _ '� LV� 1�11,�f" <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR P.0 CABLE. � o p <br /> ��� — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I <br /> I heieby ce�li(y that I l�ave read and exarnirted thrs appfieation and kno�v the sarne to be true and <br /> correcL All p�owsions ollaws and o��inances govenung fhis lype o(work�vill be comple(ed <br /> �vhether specified herein or noL !he pranting ol a pernut does not presume fo give aufhority to <br /> violate or cancel fhe provisions ol any ofher slafe or local law re9ulating consfruc6on or fhe <br /> pe�lormance o!censtrucfion. Thaf I am authorized by fhe owner of this property fo perforrn the <br /> �vork!or which application is rnade and I compty�rifh the Sfafe Contractors Law 1 fJ.27 RCW and <br /> 29G200 WAC. <br /> �"� – � , � <br /> ��i;.i�-� �/ — ��C7 – � � <br /> �,-' Si�n ture � / 7 Uate <br /> / 7 <br /> �� /_ � <br /> J / `� <br />