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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SCRVICES <br />3200 CEDAR STREET, EVERETi, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.evereltwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />�i � <br />��/%) i�r-rjii��� �l('i (�tcl(�. ���`� �'����� <br />PROJECT ADDRESS <br />Owner <br />Tenanl <br />Eleclrical Contractor <br />Slate License Number <br />Proposed Use of Buildin9 <br />A9ail Address <br />Mail Address <br />Mail Address <br />City <br />Ciry <br />City <br />yl�J �f.�,� ���J �; t— <br />Slale/Zip Phone <br />Slate/Zip Phone <br />State/Zip <br />Conlracl Price of Wor4: <br />Conlact Person (Plan Review) <br />Descnplion at Work to �e Done: Y I(' r�/ Y i� a/ i, .�� � <br />NOTE: WIRING IN NON-DWL"LLINGS IS REQUIRED TO <br />BE IN RACEWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certily fhaf 1 hat�e read and exnmined fhis applic�tion nnd know fhe sarne fo be true and <br />con�cL All provisions o/la�vs and ordinancas govemmc� fhis type o( work �vilf be completed <br />whether speci�ed herein or noL The granting ol a pernuf does nof presume to yi��e authonty to <br />violate ur cancel fhe �rovisions oI any other state or Iocal la�v regulaUng consWction or the <br />perfonnance o/ conslruction. Ihat I am authorized b}� fhe onne� ol fhis prepert}� fo perlonn the <br />work lor �vhich application is nu+de and I comply �vith fhe Stafe Centractors La�r 78.27 RCIV and <br />2962001NAC. ` , <br />� I <br />� > <br />� l`�; � � ' - ,e-, -- � t -7 <br />Signatwe �ate <br />FEE <br />{�71i��-�7/ <br />Phcne <br />