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ELECTRICAL PERMIT APPLICATION <br />CITY O� EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 42 �-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />;�,J,�y `���t�OUrf'i � <br />PROJECT ADDRESS <br />I�e����� <br />owner <br />Tenant <br />Cl���,����r���, �ac� � ���-�-�� ��1� ��c � <br />Elec�rical Conlraclor <br />Stale License Number <br />S C .I� <br />Proposed Use of Buildin9 <br />Descriplion of Work to Be Done: <br />Mail Atldress <br />Mail Address <br />M1fail Address <br />( ))� <br />ary <br />City <br />City <br />�� ��('lll <br />NOTE: WIRING IN NON-DWELLINGS IS R[QUIRED TO <br />B[ IN RACEWAYS, tv1C OR AC CABLE. <br />ti.Y,_�- �ct� <br />u�ll�� ��'r,� ��a7e �6r,�-��.s�-���� <br />StatelZip <br />Stale/Zip <br />Sfale/Zip <br />Conlract Price of Work <br />Contacl Person (Plan Review) <br />, ��L' UJ E' �' ��C, � C <br />CITY OF EVERETT LOCAI SALES TAX CODE IS 3105 <br />I hereby certify that I have read and examined this application and know Ihe smne (o be fnie and <br />correcL All provisions olla�vs nnd ordinnnces goveming fhis fype oI work u�ill6e completed <br />�vhether speciGed herein or not. The �ranling ol �� permd does not presinne to give aufho,-ity to <br />violate or cancel Ihe provisions ol.3ny olher state or local law regulating conshucGon or fhe <br />perlormance o/construction. Thaf I am authonzed by the o�ti�ner o/ (his property (o perlorm the <br />�voik lor which applicalion is made and 1 comply wilh fhe S(ate Contracfors Law 18.27 RCW and <br />29G.200 WAC:� <br />) / ,. % <br />•_ �' V N l i � � /'�� L'1 LC'�I l.?� � � /� � �� �� �� <br />FEE <br />�= o�7C �. c(.`1 <br />Phone <br />Phonc <br />Phone <br />