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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WP. 98201 <br />425-257-8810 - FAX 425-257-8857 — wwvr.everettwa.org �—'al{ � I 3 <br />1r <br />/�" � —, � <br />PROJECTADDRESS <br />j l <br />Owner <br />Tenant <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />n <br />i - <br />.�i�, � � �� _ <br />� �, � <br />u <br />,-i " � <br />� Mail Ay----- <br />Mail Address <br />; . <br />�. . ., � �f �i <br />Eleclrical Conlraclor Mail Address <br />� '� 1 ,• � <br />�� i , c . � � <br />I ' 1 <br />Slale License Number <br />, <br />Proposed Use of Building <br />Square Footage Q( residential new consUuction, remodel or addition) <br />� <br />Description of Work lo Be Done: �; <<' <br />i:� <br />Ci38�_ra� <br />+ , , <br />r- _� • I - � � <br />,1=�:' ��, ��" <br />StalelZip Phone <br />StalelZip Phone <br />\ � i , . � <br />- l'�. /i � � ' )1 <br />State2ip Phone <br />�' ` c:_- <br />, � � `'� - <br />Contracl Price of Work <br />Conlact Person (Plan Review) <br />/... L�. .. ;� <br />NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO <br />f3E IN RACEWAYS, MC OR AC CABLE. <br />i CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />i I hm�by ceriily that I have read and examined this application and kno�v fhe sarne to be tnie and <br />conect All provaions ollaws and orAmances governing Ihrs fype ol �eo�k �vill bo rompleted <br />whether specrfied heiein or noL The granting ol a penmt does not presume to gi� e a�dho!ity to <br />vwlate or cancel the I�rovisions ol any ot0er state orlocal law ragulating cons6uction orthe <br />Ipeifomiance o/cons(n�cfion. Thaf I am aulhonzed by (he oia�ner ollliis property to pedomi the <br />woik /or which applicafion is made and I comply �wfh the Sfole Confractors Law 18.27 RCW and <br />296.200 WAC. <br />� _ i �_; _ � -, <br />� � � - I �� 1 <br />- Signature - � � Date <br />FEE � D � <br />"./ (�' <br />L�(�3U1 �1''% <br />