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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> j 425-257-8810 - FAX 425-257-8857 –www.everettwa.org o� _ z� _p y <br /> I APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br /> � C' o`l�'`1 -i�'3 <br /> � .i- <br /> ;� ;' `' ,4' �%�'' ,/' ., ��' � — <br /> PROJECT ADDRESS <br /> � <br /> / . /i. .. �! �'..t� � /�� , L`X� !?oi��:��/ ✓ �-✓'�' ,/1 '�J'n"rIJ / ��✓� ,,r,�s/� '/�✓���✓C <br /> OK�ner% Mail Address Ciry State2ip Phone <br /> Tenant Mail Adaress City State/Zip Phone <br /> �N' `,, ��1._� <br /> Electrical Contractor Mail AtlCress Ci.y SlateiZip Phone <br /> Slate License Number Contract Price of Work <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Oescription of Work lo Be Done: / �' �� w Se� 1��� `�i i���✓ �'' !i �' �%l /� ��C��i � �' <br /> i�-� <br /> � �r- ;;:,r ;�� � o� e <br /> NOTE: \NIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACE4VAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 here6y certify that 1 have read and exarnined this applicafion and kno�v the same to be true ano <br /> correct. All provisions o(laws and ordinances gove•ning fh�s type of werk wil!be completed <br /> �vhether specified herein or neL T'he granting of a parmd dces net presume;o yrve authonty to <br /> violate or cancel the provisions of any o[her stafe cr'ocal la�v regu/atrng ccnstruc;ion or the <br /> peAormance of construcfion. That 1 am authorized b}�the o�vner o(fhis prepeAy to perform the <br /> �vork lor which applicnuon is maae and 1 comply u�ith;he State Contraciers Law 18.2i RCW and <br /> 296.200 WA C. <br /> /w, ,��' <br /> Sig� lure Date <br /> ,—cn10� -103 <br />