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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 />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />- C��' ,:�� � C�c�� (�� �--e <br />PROJECT ADDRESS <br />�v� <br />,�VL <br />Owner <br />Tenant <br />\ )� � •� ( � ��, f ��,,�— <br />Mal�Addross c I Cily <br />hlail Address City <br />� .'� L'��(�i-.Ci'� <br />Eleclrical Conlmctor Mail Address <br />Slate License Number <br />�, � <br />Propo�ed Use of �uilding <br />� <br />Description ol 1Nork to De Donc� LU �� � <br />NOTE 4VIRING IN NON-DWELUNGS IS REQUIRED TO <br />BE IN RACEWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SAIES TAX CODE IS 3105 <br />Cily <br />t�'-"\ <br />rr'� -='`� � <br />Stale/Zlp <br />Stale/Zip <br />Sta�e/Zip <br />Contract Price of Work <br />t Phone <br />c{�-z� 3 <br />Contacl Person (Pian Review) <br />I hereby certily fhaf I have reod and examined fhis applicafion and know fhe sarno to be true and <br />correcL A(I provisions o/laws and ordinances govem�ng fhis type ol work ���ill be complefed <br />�rhefher spucilied herein or noL The �ranting o( a pernuf does not �resume fo g;ve authonly fo <br />��iolafe u� cancel fhe provisions o! any other state or local la�r regulafing construction or fhe <br />perforn�anr,e o/ censtruction. rhaf 1 arn �ufhorized 6y (he owner ol fhis property to perfonn the <br />u�ork lor �vhich applicafion is made and 1 comply trifh the Stafe Contractors Ln�v 18.7.7 RCW anA <br />296.200 11�AC. <br />�? � 1 �,; i l � � a i, (Z, �� L: � i�.i �' i.;L ��,. <br />aignaturq U 1 ua�e .r- � <br />i'�"C-L� C�L,.: �Sr�`, ""L�' �..ri.�n:Ti<j Gv� .�PCI71C�.� <br />�`>5�� Cl �v�. ��wVt.L� —�0,����2�C.��7� <br />- �/�,�/,..., � <br />Phone <br />Phone <br />FEE <br />� �u�2- ��3 <br />