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ELECTRICAL PERMIT APPLICATION <br />CITY �F EVERETT PERMIT SERVICES <br />^200 CEDAR STREET, EVERETT, WA 98201 <br />425-�57-8810 - FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />( � �05 r��or�Tp,�;� �or 3 <br />PROJECT ADDRESS <br />LA�E��tiO {-k�rn�S <br />Owner Mail Address <br />Tenant <br />Eiectrical Contraclor <br />�1 M M IE� �CX�K Z <br />Slate License Number <br />��L <br />Proposed Use of Buildinc� <br />Mail Address <br />Mail Address <br />City <br />Cily <br />Cily <br />Description bf Work lo De Done: _ (`J j/.s� /`][�W SF ir�— <br />NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO <br />BC IN RACEWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />State2ip <br />State/Zip <br />State2ip <br />ysa�� <br />Contract Price of Work <br />Cootact Person (Plan Review) <br />1 hereby certify thal 1 hav� read and examined fhis applir.ation and know the same to be true and <br />conecl. All provisions ollaws �nd oidinances governmc� this lype o/work �vill be complefed <br />whefher speafied herein or noL The c�ranling o/ a pernut does nof reswne to give aufhonty to <br />violate or cancel llie provisions o/ any other sfate or local law rec�uPting constnic(ion or fhe <br />pedomiance o! conslruc6on. That 1 am authorized by fhe owner ol this property fo per/onn the <br />�vcrk lor �vhich applicafion is made and 1 comply with fhe Sfate Conht�ctors Law 18.27 RCW and <br />296.200 WAC. <br />W <br />�� <br />—/ G � <br />FEE <br />Phone <br />Phone <br />Phone <br />