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ELECTRICAL PERMIT APPLICATION <br />CITX OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />�� ���/ � �/, -l���;'r- L�v' <br />PROJECT ADDRESS <br />; �, /;�/1 /;`�/-�`�`/% <br />Own�r Mail Address <br />�/�/�� r- <br />City StatelZip <br />� /,�„ ( <br />TenaN M14ail Addmss Ciry <br />/ r/ / / <br />/ �/�/�Jy.,_`.. c`� %� i!-Y � S /C- L'�/•r�N �ilt� _ <br />Eleclrical Conlraclor Mail Address City <br />���' � �-_ . 7 <br />..! �:� �"'= <br />Slate License Number <br />� <br />/� C r�v7` <br />Proposed Use o( Building <br />Descriplion of Work to Be Done: !/�'7' 7� <br />NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO <br />BE IN RACEWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />Stale/Zip <br />w/ JC <br />State/Zip <br />, �:� <br />� �'. <br />Phone <br />Phone <br />� "'C��'� <br />- % s !/ 2 I - �l Z/ <br />� <br />Phone <br />Contract Price o( Work <br />. � ', � <br />Conlacl Person (Plan Review) <br />I hereby certily fl;at I have read and examined this applicafion and kno�v fhe same to be Vue and <br />correct. All provisions o/ la�vs and ordinances c�overnmg fhis type o( work �vill be complefed <br />whefher specdied herein or noL The granting ola pernut does not resume to give authonty to <br />violafe or cancel the I�rovisions olany other sfate or locallaw reguPafing construction or the <br />perlonnance o/ construction. Tha11 am authaized by the owner o/ this propeRy to pedomi the <br />work lor which applicafion is made and 1 comply wdh the State Confraclors Law 18.27 RCW and <br />296.200 WAC. <br />: : .,:�; �� _ 1.�- �/- '< �=� <br />' Si9nature Dale <br />FEE <br />/� 2 G�, <br />�U <br />