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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 <br /> ��G �i c� � �(� . C��E��ri �1/� `1 ����0 <br /> PROJECT ADDRESS <br /> ��, c, l< < � ( ;��a�-�G � GSLur� ? 3�a - �S��� P� sc����-�� c�� ��a0� <br /> Owner MailAdd� s Clty Statr��as J �,��_Phone�O <br /> r�� <br /> Tonanl Mail Address City State/Zip Phone <br /> G'(,�Vc.c R <br /> Electrical Conlractor Mail Address City Slate/Zip Phone <br /> Stale License Number Conlract Price of 1Nork <br /> Proposed Use of Building Conlact Person (Plan Review) <br /> Description of Work ta Be�ono: 'P ��l ���R�S ���� ("n ' <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE CJ <br /> BE IN RACEWAYS, MC OR AC CABLE. ' O � <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certi(y that 1 havo rend ond examined fhis application and know the seme fo 6e truo and r <br /> correcL All provlslons ollaws and ordinances govemmg(his type of work wi/16e completed I � � Z �d �P� <br /> whefher specifred herein or not The granfing o/a permd does notp resume to give authonty fo <br /> violato or cancel tho Provisions ol any ofher sfato or local law regulating consWcfion or the <br /> performance of consfruction. That 1 am authonzed by the owner o(thfs�roperty to pedorm the <br /> work lor which applica(ion is ntade and 1 comply with fho S(afe Contractors Lew 18.27 RC W and <br /> 296.200 WAC. <br /> � <br /> ' � � �tl� �d D� // <br /> S gnalure Date " � <br />