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ELECTRICAL PERMIT APPLICATION <br />CITI' OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — H^r,v.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />_'� '�) L� �I�l�t�\1 1' I��f I l i- �� <br />PROJECT ADDRESS <br />Owner <br />ienant <br />�t-I�/t (=1Jtr <br />Electrical Conlractor <br />►�� <br />A1ai� Address <br />Mail Address <br />A7ail Address <br />1�►(hc��� ;t���o <br />State License Nwnber T— <br />Proposed Use of Building <br />Description of 'JJork to 8e Done: IM L <br />NOTE: WIRING IN NON-DW[Ll_INGS IS RE�UIRED TO <br />BE IN RACEWAYS, A4C OR AC I;ABLE. <br />CITY OF EVERE7T LOCAL SALES 1'AX CODE IS 3105 <br />City <br />Qly <br />�IU� <br />City <br />� <br />State/Zip <br />Slate.2ip <br />� �..�1 <br />Stale2ip <br />i��� � <br />Conlract Price o( Work <br />���1 <br />�J�-_ <br />Ph ne <br />3�8 5z�i <br />,�o; <br />Phone <br />�Cn t4 <br />�Z����3 <br />PhOne <br />Contact Person (Plan Review) <br />I here6y cerii/�� thaf I have read ar.d eaamined fhis aFplication and kno�v fhe same fo be true and <br />correct All provisians nl laws :�nd ordinances go��e�nrng fhis type o( work wiil be completed <br />a�hefher spea(ied herem or noL The granfin� o/ a pernuf does nof resume to give authonty to <br />violafe or cancel (he provisions o! any efher state or local /aw reguPting consfruction or the <br />perfonnance o(construction. Thaf 1 am aufhonzed by the ownerolthis property to perform the <br />work la- which applicafion i made and 1 compty �rilh the Sfate Contractois Law 18.27 RCW and <br />796.200 Ih�A C. <br />i .y_-- - - <br />/' / °_ <br />FEE <br />, <br />' � %' / � � �% <br />�� � <br />