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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 � Z —l7 —(J7 <br /> �;o ��z-o� `� <br /> �]335 �,v��- �a,u� <br /> PROJECT ADDRESS <br /> Owner Mail Address Ciry Stale2ip Phone <br /> / <br /> Tenant Mail Address City State.2ip Phone <br /> �I�'�t?�� `� ` ( C <br /> C-lectrical ConUaclo� Mail Address City SlatelZip Phone <br /> ��f�-(� CC,t. ( �{ �l �� ,�jU�d .,, <br /> Stale License Number Contract Price of Work <br /> C�CNS�OS <br /> ProposeA Use uf Ouilding Contact Person (Plar� Review) <br /> 7 <br /> Description of Work ta f3e Dona r� �=-/'t'��t�(�i-L. ��C[-��C: - �r._,`� •{ ��/W �I�L�" - <br /> �+�.`(/�� ��'��i - <br /> NOTE: �VIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, A1C OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 heieby certi!}�that 1 have read and examineA this ap�lication and kno�v fhe sarne to be Vue and <br /> correcL All provisions olla�vs anAordinances govermng flus lype ol�rork will be completed <br /> whefher spealied herein or noL The granfing o/a permrt does not presume fo give authonty to <br /> violate or cancel fhe provisions o/any olher sfafe or local/an�regulating construc6on or the <br /> perfonnance o(construc6on. That 1 am authorized by fhe owner o/fhis praperty to perform Ihe <br /> wo�k!or�tihich applica$on is made and I comply with the Stafe Conlractors Law 7827 RCW and <br /> 29G.200 WAC. <br /> 1 - ' ' <br /> l; ��-i� i �i`� l C "I � a �? <br /> Sic�naturc I�I - Date - j - . � , / <br /> t � <br /> � r ' �� <br />