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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SE�VICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-885? —www,evereitwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> , <br /> L <br /> �� � 1�1 �� ������: � �.��-�- r l_���� ��: - � <br /> PROJECT ADDRES �S�I_l�a I � <br /> � , �5 I-g�� <br /> - -� � �,� �� . .�_�� � 1,� z �� (���_n, ;- c �� ,�,� •- - �' - _�.��� - <br /> ���.�� % ', <br /> Owner �— Mail AdAress City Slate2ip � Phone <br /> Tenanl Mail Atldress City State/Zip Phone <br /> � �C' �:l'1N ( %ll_';�`(� ;-' <br /> Electrical Contractor Mail Address Ciry Slate/Zip Phone <br /> State Lic�nse Number Conlract Pnce of Work <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Description of Work to Be�ane: 1 (1 Z. �_ L 1'LN � ' , � ` � � � "� <br /> . ' �, . — <br /> �.��" ,��'' Z('_�4 �.� �� �' � .`�� � ��,�Y�L.�. �l. `'l, �'C. (� <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> P= IN R,4CEWAYS, MC OR AC CABLE. c� �_�`�, ��� <br /> CITY OF EVERETT LOCAL 3ALES TAX CODE IS 3105 <br /> l hereby ceRily that f have read and examined�his aoplicaticn and',no�v the same to 6e true and <br /> correc7. All provisions ol laws and ordinances govemmg this type ol work•.vill be cempleted <br /> whe[her specified herein cr not The granting ol a permd dces notp resume to give authority to <br /> violate or cancel the provisions of any ofher state orlocal law regu/ating consWcfion or ihe <br /> performance of construcLon. That/am authonzed by the owner of this property to perform fhe <br /> work lor whicn applicaticn is made and I comply with the Sfate Contractors Law 78.27 RCW and <br /> 296.200.WAC. <br /> i <br /> , �l i.t � �,� :�� � �J ��'� �1-/;� �('��(_� <br /> Signature ' Date �p� �'_d(a'� <br /> � � / — (,�1.>� � <br />