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ELECTRICAL PERMIT APP��ICATION <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 /> f�`1����'(�i°i/�( _i�t� /� ,.�r � � � <br /> PROJECT ADDRESS <br /> � � <br /> � �� G � iJ�i� � n-rll' /� <br /> Owner Mail Addmss Ciry Sla1e/Zip Phone <br /> Tenant Mail Address City StatelLi Phone <br /> C�,�� � ./ � c��� ��a-��pi6�; <br /> ' ^ �o� <br /> /// � J�JiJ�,/ l :Nf l/; �r ��I`•3U.h j�'� �uY. /.� J C.��,.����.1s 7 � <br /> Eleclrical Contraclor Mail Address Cily State/Zip Phone <br /> %����%N���/o'�i�� �h�`�= <br /> Stale License Number Contracl Price of Work <br /> Proposed Use of 8uilding Conlacl Person (Plan Review) <br /> �/ <� /Jn <br /> Descriplion of Work lo Be Done: c�C n���n O[vX'•Q / �'� �. <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cedily fhaf 1 have read and examined this application and know the same fo be true and <br /> correcL All provisions o(laws and ordinances goveming fhis type oI work will be complefed <br /> whe!her specified herein or noL The granting o!a pemut does not presume to give aulhonty to <br /> violateorcancellhe provisionso(an}�otherstafeorlocallawregulafingconstruclionorfhe <br /> performance o/conslrucfion. That 1 am aidhonzed by the owner o/fhis properly to perform fhe <br /> work lor�rhich application is made and 1 contpty wilh Ihe State Contractors Law 18.27 RC W and <br /> 296.200 WAC. <br /> �,�1 �e �Jn E' ,�� 1- /- �� � <br /> oignature / Date <br /> F�z-vo3 <br />