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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.evereltwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM S�3 �-0� <br />`_ ,;'`� S �,;�� ;���e Sn /�I 17 . �S�c" �7 ����iE�1,� , ��r;� . <br />F�ROJECT ADORESS <br />Ownef <br />u <br />Electricai Contraclor <br />l3� sTE�.ko � v M � <br />Slale License Number <br />\ <br />�9 „� �y,z � � <br />Proposed Use of Buildinc� <br />Descriplion o( Work lo Be Done: <br />Mail Address <br />Mail Address <br />Mail Address <br />� <br />0 <br />�� <br />NOTE: WIRING IN NUN-DWELLINGS IS REQUIRED TO <br />BE IN RAC�1vAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />Cily <br />Cily <br />City <br />Slale/Zip <br />� � <br />Slale2ip <br />Phone <br />'r•'�il <br />'�� ' <br />�g6 1�-d7%-� <br />Slate/Zip Phone <br />� 3 OD�, �� <br />� <br />Conlracl Price o( Work <br />Contacl Person (Plan Review) <br />I hereby certily fh��t I have read and examined fhis application and know the sarne to be true and <br />correcL A/l prowsions ol laws and ordinances governmg (his type o( work �vill be completed <br />tvhe0�er spea/ied herein or not The granting o/ a permd does not presume fo give authonty to <br />violate o� cancel fhe provisions olany other state or local la�v regulating construcfion or the <br />perfonnance of consfruction. That 1 am authorized by the avner o! this preperty to perfomi the <br />�vork for �rhich application is made and 1 compty �+�ith the S(ale Contractors Law ]8.27 RCW and <br />296.200 WAC. <br />.,, <br />m <br />FEE <br />� U�,CS- zaG <br />r/�! I <br />