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( <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, 4VA 98201 <br /> 425-257-8810 - FAX 425-257-8857 -www.everettwa.org <br /> APPLI(:ATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> {� � r <br /> ���0/ 0 i�!� 5 �. L- l�v�Gc� . ,,., . <br /> PROJECT ADDRESS <br /> � l 1 ., - / < /4 <br /> 4�t�L �. � /l�'ic�it•�y �ZC!/Ci �glrJv��lG /4'� . �'� 1�� � 4/Cj'/c'r) i'll "( . �0' Zl� j�C�e/�'CJli' . 0 <br /> U, <br /> Ownef Mail Address City State2ip Phone <br /> �. �i� .�!��� <br /> Tenant Mail Address City State/Zip Phone <br /> Electrical Conlractor Mail Atldress Ciry SWte/Zip Phone <br /> State License Number Contract Price of Work <br /> � ,,,.�,1� F�����, ;c.� �, � WI � <br /> Propdsed Use of 8uilding Contact Person (Plan Review) <br /> Desr.ription o(Work to Be Done: (��- ��� � �C�. �1 0.:�C_ <br /> NOTE: INIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY'OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certif}�thaf 1 have read and examined fhis application and kno�v the same fo be troe and E �'��V � ��' � <br /> corr_ct. All prcvisions of/aws and ordinances govemmg�his type o(work wi/16e completed <br /> whether speci�e�herein or not. The granting cl a permd does not presume to give aufhonty to <br /> violate or cancel the pruvisions o/any o(her state or/ocal law regu/ating construcnon or the <br /> periormance of construc:r�n, rh�t f am authonzed by the owner oRhis propeRy to peAorm the <br /> �vak lor which applicatiun is made and 1 comply�vith the State Contracrors Law 18.27 RCW and <br /> 296.Z00 WAC. <br /> c <br /> � <br /> ��.... ��� �����A�o�`'=+A � � �) �� � � <br /> tSignature ` Date <br />