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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98?'�1 � _a-(( —{�(� <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org C'O 60`7�-I�7 <br /> APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM <br /> � 1 <br /> i - � <br /> � ���� �/[�Q/���� ���'{� � <br /> PROJECT ADDRESS <br /> Owner A1ail Address City Slale/Zip phone <br /> Tonanl Mail Addrcss City Slate/Zip Phonc <br /> �1��C/�'1i',{ � <br /> ElecUical Contrador Mail Address Ciry StalMZip phone <br /> State License Number Contract Price of Work <br /> Proposed Use of Ouilding Conlact Person (Plan Review) <br /> % _ <br /> i <br /> Description o(Work lo Oc Done: � � � � ' 'y <br /> � � <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> D[ IN RACEWAYS, MC OR AC CABLE. <br /> I <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereLy certify fha(1 have read��nd examined this application and know fhe same fo be tn�e and <br /> correct. All provisions of laws and orxlinances�ovemuig fhis type ol work will be complefed <br /> whefher spec�6ed herein or noL The grc�nfing ol a pamrt does not resume fo give authonty to <br /> viofafe or cancel the provisiens oI any ofher sfafe or local!aw raguPating construchon or the <br /> pedomiance o/construction. That 1 am aidhonzed by fhe o�rner o/fhis property fo po�fomi Iho <br /> wo�k lor which applicalion is made and I comply with fhe Sfafe Contracfors Law 18.27 RCW and <br /> 296.200 lh�A C. <br /> � <br /> 7� /�:.Y/����.c� i".,}.d J� %�-%� -L�i0 <br /> �' �Slgnature - Dale <br /> ! <br /> �Ob? �/3 <br />