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ELECTRiCAL PERMIT APPLICATION <br />CITY QF EVERETT PERMiT SERVICES <br />3200 CED/�R STREET, EVERETT, WA 98201 <br />425-;'S?-8810 - FA;: �25-257-8857 — www.everettwa.org <br />APPUCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ��`« — t�� <br />. <br />�� � r� / <br />� /L��,��,�C l ��l/�'�7.c�� � <br />PROJECT ADDRESS <br />Owner <br />Tenant <br />Electrical Contractn; <br />Sta�e License Number <br />Use of Building <br />Description of Work lo De Done: <br />MailAddress <br />Mall AdAress <br />tatoil Atldicss <br />NOTE: WIRING IN NON-DWELLINGS IS RE�UIRED TO <br />BE IN RACEWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby ceriily Ihaf I have read and examined this applic <br />cunecL �UI provisions o/laws and ordinances governmg <br />whetherspecilied herein or noL The �ranting o!a pernuf <br />violafe or cancel Ihe provisions oI any other sfate er Icca <br />performance o/cons(ruc6on. 7hat I am aufhorized by fh <br />wo�k lor which application is made and / comply wilh Ihe <br />296.20O WAG. I % <br />Cily <br />City <br />City <br />E c,�=���_osy <br />StatelZip <br />Stat�/Zip <br />S!ate/Zip <br />Contracl Price of Work <br />Conlacl Person (Plan Review) <br />afion and kno�v fhe same to be true and <br />this type ol �vork will be completed <br />does not resume fo gi��e authority fo <br />l la�v reguPting construclion or the <br />e owner ol fhrs property to peiiorm the <br />Sfate Confractors Lan� 18.27 RCVJ and <br />/ � <br />: � �; %�Lv �'i� � � � L 6 � <br />FEE <br />� <br />�� <br />Phane <br />Phone <br />Phone <br />�"// -�55� <br />