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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETf, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> _� ��b �' DL�(Iti'r/'IC Q�' , <br /> PROJECT ADDRESS <br /> n 7� <br /> L�X�(..���o /,���c5 T,�� ��� ��x ��1�' C..k= 5����<tI� LJ✓ 1�2�b' 3x -���/ <br /> Owner MailAddress Cily State2ip Phone <br /> R:nanl Mail Address City Slale2ip Phone <br /> Electrical Conlraclor Mail Address City Slate/Zip Phone <br /> Slale Licenso IJumber Conlract Price of Work <br /> Proposed Use of Building Conlact Person (Pian Roview) <br /> �-- e <br /> Descriplion o!Work to �c Donc: _I��1�✓r dWr-{� <br /> NOTL: WIRING IN NON-DWELLINGS IS FEQUIRED TO FEE <br /> �E IN RACEWAYS, MC OR AC CADLE. <br /> CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> 1 hereby certily lhaf 1 have reuAand examined fhis ap/�licafion and knrnv fhe sante fo be Oue and <br /> correct. All p�ovisions ollaws and or�linances got�errung this f�pe o(work t+ill be complefed <br /> whether spec�fird herein or noL The�ranfing ol a pernut does not �resun;o fo give aufhonty fo <br /> violafe or cancel fhe provisiens oI ar�y ofher state orlocal law regulafing cwutrucLon or the <br /> performance o/consUuc6on. Thaf 1 am authorized by fhe u�sner ol(his property fo perlorm Ihe <br /> �rork lor ivf�ich application is made and I comply n�ith the Stafe Con6actors Law 18.27 RCW and <br /> por.p00 INAC. <br /> �-- f�� �i.l� � � <br /> i /�' i <br /> ��_�__����. ; A� C� ,3�/O / <br /> Sinn�ture Uato <br />