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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 —w+��rw.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> t� oZ � l�'��'E.� <br /> PROJECT ADDRESS <br /> i <br /> /hl � N�«� �tl,?�k G ✓c,� ;i �v;� -/zz �sz. 5 <br /> OWner ldail Address City Slate2ip Phone <br /> TCnanl Mail Addreas Cily Slate!Zip Phone <br /> GlZ AIJ j�C� �Lf� r T2 � c /N c c-r/ 9�Li3 ;�sa u�.� <br /> Electrical Conlraclor htai�Address Gty State�Zip Phone <br /> ��A /JIE( `yt'�3Lr.� <br /> S�ale License Number �ontract Price of Worh <br /> Sf ' �C� <br /> Proposed Use of Duildini� Conlacl Person (Plan Review) <br /> Description o(Wo�k lo Be Done: �h���� � �'��G✓ � T s (,�� <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE � <br /> BE IN RACEWAYS, h1C OR AC CA4LE. // � C7 <br /> / <br /> CITY OF EVERETT LOCAL SAIES TAX CODE IS 3105 <br /> 1 heieby cerfi!}�fhat I have read r�nd exarnined this applicafion and know fhe same to be frve and <br /> conecL All prowsions o/laws and ordinnnces�overning lhis fype of�vork�rill be complefed <br /> �vhelhcr specili��d herein or not The�rantint�oI a pernut does nof resume to�ive au(honty to <br /> vir/afe or cancel fhe provisions ol any ofher stale or local law reguPting consfruc6on or fhe <br /> perfomiance o�construchon. That 1 arn authorized.by the owner ol Uus;..operty to perlorm the <br /> work/or�vhich apphcafion is made and 1 cornply wdh the State ConVacfors La�v 18.27 RCW and <br /> 296200 WAC. <br /> ---� , d _G . <br /> -�z--' � ��,`-" �- � <br /> SignatuiR D�Ic <br /> EG�`��°�5 <br />