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l <br />ELECiRICAL PERMIT APPLIGATIAN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 96201 <br />425-257-881U - FAX 425-257-8857 — www.evereriwa.crg <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />I��1���> ►�'1c��� � n�� �� <br />PROJECTADDRESS <br />I� J/\5 i� I lU 7��' <br />owne� <br />Tenant <br />�n� <br />Mail Address <br />Mail Atldress <br />Contractor � Mail Add�ess <br />1 t�, ��� ov � � o� s I; c <br />State Ucense Number <br />Proposed Use ol Bwlding <br />Description of Work to Be Done: <br />NOTE: WIRING IN NON-DWELLINGS IS RE�UIRED TO <br />BE IN R,4CEWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hnroby coAily (hat I have mad and oxaminod fhis applic2fion and <br />cormcf All p�ovisions olla�vs and ordinancos goveming fhis rype <br />tvhelhe� spocilied ha�uin or nof. Tho gran(ing ol a porrnd does nof <br />violafo or cancol the provisions olany ofher sfate or locallaw regu <br />pedonnanco o/constn�clion. Thaf I arn aufhonzed by fho mvner o <br />�vo�k lor which applicafron is made and I cornpty wifh fhe State Coi <br />296.200 WAC. �-, <br />-� <br />Cily Slate2ip <br />4�'S — i /' 7_ <br />a�y <br />Cily <br />1 <br />Phone <br />Sta�e/Zip Phone <br />? <br />Nl�.�/ihC11l �1�����(1N►4�r <br />State2ip Lf 2�,�SS on� 6 <br />Contract Price ot Wcrk <br />C� i{lYiri.� \ P \ %f1'!'� _ <br />Contact Person (Plan Review) <br />lo be fn�e and <br />ompleted <br />i authonly to <br />FEE <br />���C� - � �� <br />