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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />42�-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />�/ � �/'7/,��, � <br />ROJECT ADDRESS <br />�i <br />iz'��-d <br />owner <br />Tenanl <br />� � A1ail Address <br />�i lc�,���Hn�t� <br />Electrical Contracloi <br />Slale License Number <br />Proposed Use of Ouildmg <br />Description of Work lo Be Done: <br />Mail Address <br />Mail Address <br />fdOTE: WIRING IN NON-DWELLINGS IS REG�UIRED TO <br />BE IN RAC[WAYS, MC OR AC CABLE. <br />Cily <br />Ciry <br />Cily <br />cr� �'f��� � <br />Slale/Zip <br />Slate/Zip <br />SlateRip <br />Conlract Price o( Work <br />Contact Person (Plan Review) <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby certily fhat I have read and examined fhis application and know the sarne to be true and <br />conecL All provisions ollaws and ordinances governuig fhis fype ol work will be cornpleted <br />whether specJ�ed herein or not The gronting o( a pemuf does not reumie to grve aulhonty fo <br />violate or cancel the provisions oI any other sf�te or local law reguPting conshuchon or fhe <br />perfoifiiance o� conslruction. That I am aufhonred by the o�rner ol this property fo perlomi fhe <br />work (cr �shidi application is rnade and 1 cornply wifh fhe Stafe Contractors Law 1827 RCW and <br />29G.200 WAC. <br />FEE <br />C ULU1-C�S�I <br />3.E'�z <br />Phone <br />Phone <br />Phonc <br />