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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />;;200 CEDAR STREET, EVERETi', WA :�8201 <br />425-257-8810 - FAX 425-257-8857 — wnrw.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />% � M� ,I��� /1��_ %���-�a. <br />PROJECT ADDRESS <br />Z--a.( �o� <br />�� �o6.H�s^�•� /�C�( G.-��_,- Sa- ����•� �7 M����,s•�, Ilc `.J/9. `>��?o <br />Ownef A1ail Address Ciry � State2lp phone <br />Tenanl <br />t.tiil Address <br />City <br />StatelZip <br />C''c+�C U�'/� %� � c` `�-�' i C <br />Electrical Contractor ra❑�i nddress Ciry Sime�Zip <br />State I_icense Number <br />.5 �=12 <br />Proposed Use of Building <br />Descriplion af Work lo Bo Done: <br />NO i'E: WIRING IN NON-DWELLINGS IS REQUIRED Tn <br />EE IN RACEWAYS, f.1C OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />Contracl Prico of Work <br />Contact Person (Plan Review) <br />I here6y certily (hat 1 have read and examinad this application and know fhe same to be true and <br />correcL A/l provisions ol/aws tnd ordinances govemmg Ihis t}�pe ol work �vill be complefed <br />whetl;erspec�lied herein or nrc The c�ranting o/n pernut does not resume fo give authonty fo <br />violate or c�ncel fhe I�rovisions o,' any ., ther state or local lau� reguPfing construction or the <br />performance ol consfruclion. � hat I am autho�ized by the owner ol fhis property to perform the <br />work ror �vhicff applicafion is m�de and I. ornply �sith Ihe Sfate Confracfors Law 18.27 RCIV and <br />29�.2001NAC. <br />��� �;�.�� „-e_ IZ-Z(-�s <br />� � eWre Date <br />FEE <br />� <br />,r S <br />EGilz-I�� <br />Phone <br />Phonc <br />