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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETf, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />�303 1�1<<l,�„�1�11 {�v- <br />PROJECT ADDRESS � <br />Owner <br />l�-ir � r 5i <br />Electrical Conlraclor <br />Mail Address <br />��. � <br />�� Mail Addrass <br />u5%i :13�0 <br />Mail Addrass <br />l� v� 2 �- I_ ; �. y!, !- 1� �J <br />State License Number <br />��0,'�5 <br />Proposed so of Building <br />Description of Work lo �e Done: �><' � �t V <br />NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO <br />BE IN RACEWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certi(y ffiaf l liave read nnd examined Ihis applic, <br />correcL All p�avisions ollaws and or�iinances govenung <br />wftefher speafied hemin ornot The granting el a perrnd <br />� iolale or cancel tho provisions of pny other sfate or local <br />�o k(or w�i chf� o fcafor�is n ade araid I corior�zedtb}fh�o� <br />29G.200 WAC. �P � y <br />. �:�i � • � � � T�� <br />� - Sionaturu <br />Ci�y <br />l <br />� 1 f � <br />.j � �) iYl Q <br />Cily <br />State2ip <br />. . �� F <br />State/Zip <br />Slale/Zip <br />Phone <br />4? � <br />�;,-�1��� <br />Phono <br />- vvs v5 5 <br />Phone <br />�� �oU <br />Conlract Price of Work <br />I��-� r.r � ��vc�e / � <br />r <br />Contact Person (Plan Review) <br />fion and know the sarne to be 6ue and <br />his q�pe ot work will be cornplefed <br />ioes not presurne to give authonty fo <br />'n�v regulating construcfion or fhe <br />o�tner ol this property to pedonn fhe <br />;tate Contracfors Law 18.27 RCW and <br />�� - ti " �� � <br />FEE <br />� IDOy- 0�`� <br />