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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.everettwa.org <br />APPLICATfONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />_ � �. � `! �C �9 lV l � JQ. )/� <br />PROJECT ADORESS <br />�iR� cn�,r ,� <br />oW��� <br />Mail Address <br />�� <br />Clty <br />� --�-a.-c�� <br />�c�iCG-ICfJ <br />�� 2 S <br />2sy' <br />/, ye� y� <br />I�.�G / � <br />Slale/Zip Phone <br />Tenanl A7ail Address Cily State/Zip � Z J Phone <br />�'��'i_An,�n SrS ����i �V .�9.r frl/ /�,-f2c/ �s9Z/� <br />Eleclrical Contraclor Mail Address City Slale/Zip Phone <br />ft�l—,� /la II'/ y � �/> <br />Slato Licensc Numbcr <br />_ �! r�� <br />Proposcd Usc o( �uildiny <br />Description ol Work lo Oe Done: <br />V <br />NOT[: WIRING IN NON-DWELLINGS IS RE�UIRED TO <br />9E IN RACEWAI'S, MC OR AC CABLG. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />Contract Price of Work <br />Contact Person (Plan Review) <br />1 hereby certil}� fhaf I have mad nnd exnmined fhis application end kno�v the san�e to be true and <br />correct. All p�ovisions o! la�rs and ordinances govemuig Ihis t}�po of work will be cornplefed <br />a hefher spcafied herein or not The granting ol a pernuf does not prosume fo give aufhcnty to <br />�dol��te or cancel U�e provisions ol any ofher state or local la�r rec�uleting construcfion or fhe <br />perfomwnce oI cons�nicfion. Thnt 1 am authonzed b}� fhe owner o/ this property fo perfonn the <br />�rork lor �Uhich application is ru��de and 1 canply u�ifh fhe Stafe Confnctors Law 18.27 RCW and <br />296.200 INAC. <br />G /2 Z <br />FEE <br />J�� .! <br />F_��/��G�-/C� <br />