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ELECT�tICAL PERMIT APPLICATION <br />CITY OF EVERETT P�RMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX R25-257-8857 — tvw�v.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM y_ V�_p <br />, � , ) �J <br />�i ��� �-C�' //�%(.')ls�«' <br />PROJECT ADDRESS <br />OWner <br />i <br />i ,-L�� �, <br />Tenanl <br />Eleclrical Coniraclor <br />S�ate Licensc Numbcr <br />A1ail Address <br />/� �_ (l <br />Mall Address <br />Afail Addmss <br />Proposed Use ot Building <br />1.� <br />Descriplion of Work lo Be Done: <br />NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO <br />BE IN RACEWAYS, MC OR AC CADLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />Cily <br />City <br />Cilj <br />���' �U �l ���� <br />S�aICIL'Ij) <br />StaterZip <br />State2ip <br />Contract Price of Work <br />Conlacl Person (Plan Review) <br />1 hereUy cerfily Inaf I have read and examined Oiis application and know the same to be true and <br />correct. All provis�ons e/ la�rs and ordinances governmg (his type o( �vorl< <sill be complefed <br />u�hether specdied herein or noL The granting ol a pernu( dues nof iresume lo �ive authonty lo <br />viclafe or cancel fhe rnovisions o! an}� ofher stafe or local law ro9ulafing cunsfruc6on or fhe <br />perlormance o/ constnicfion. That 1 am au(horized by the o�rner o! fhrs properly to perfomi the <br />work lur �vhich applicalion is made and 1 compty �vith !he Sfate Cont�actors Lau• 18.27 RC41 and <br />29G.200 IYAC. <br />_ � -� . , 7 % � <br />FEE <br />Cl�ipy -���c I <br />Pnoce <br />Phone <br />Phone <br />