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ELECTRICAL PERMIT APPLICATION <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 />� � �/ <br />� I���-' � ��I�� ��/G� v q�.. l I C,L'i' <br />PRO,ItCTADDRESS -J <br />Owncr <br />Tenanl <br />\�� �f����- 2'/,� <br />Electrical Contraclor <br />Slato Licenso Number <br />Proposed Use af Buildinc� <br />Descnption of Work to �e Dono <br />Mail Address <br />Mail Address <br />_. �i <br />Mail AdJress <br />NOTE: WIRING IN NON•DWELLINGS IS REQUIRED TO <br />B[ IN RACEWAYS, MC UR AC CABLE. <br />Cily <br />State2ip <br />Slate/Zip <br />Phone <br />Phone <br />� <br />; /, n. l: �i Lci/!f .-f -�; <br />/ Sta%2ip � Phone <br />�/.�'� - 7 ? C - ��E % ; <br />Conlracl Price of Work <br />Conlact Person (Plan Review) <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby cnrtify fhaf I have read and exmnined Ihis applicalion and kno�v fhe same to be frue and <br />conLct. �lll provisions o(la�vs and a�dinances gov�rnmc� this fype ol �rork will 6e con:r �nted <br />whefher specifieAl�erein ornoL The �ranfing ol a pennd doi�s nef �resurne fo give autl�c�ity (o <br />viulate or cancel fhe pruvisiens o(nny e(her sfafe er local la�v re�ulating constructicn orthe <br />peiformance o/cons6uction. ihat 1 am author+zed by fhe owner o( fhis property fo pedr.m fhe <br />�rork lor wAich application is nrede and 1 canply t�ifh the Sfate Centr��ctors Law 18.27 RCW anA <br />29G.200 WAC. <br />, � ` c• <br />� � c' � � �-L� i � __ _--- % — �— � <br />� i- Signature Da�a <br />� <br />