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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 �,' - l� -a5 <br />425-257-8810 - FAX 425-257-8857 -www.everettwa.org � ps0 � d <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />� ',i <br />, , �� ., � , .. <br />PROJECT ADDRESS <br />�I. �li ��. .I . � <br />Owner <br />n <br />'�I� �'7: ;� � � �I, j ��' . � � � <br />Tenant <br />��%1�1 ��1�� <br />� 11 (`'_ii <br />Mail Address <br />Electrical Conlractor Mail Address <br />„� ,� <br />��.�'� - � � � � �. � �� �'�i�� : �. i A- <br />� <br />State License Number <br />� \ <br />r � - � , � ���� <br />� ��' , f�^.��1�'% t��t�';��� ; <br />— — �' <br />� � <br />i <br />` � � �' �' �' � _' . � �� .' ] � ,-, ;; , � ` � � � ' 1��`, <br />i <br />City Sfate/Zip Phone <br />City <br />l_ �'a:�\1�,��1 <br />City <br />Proposed Use of 8uilding <br />Descriplion of Work lo Be Dona ������,_� � ���-\�1 �\_ l.1-�J1 <br />� �`, .' �,\,_ � � `�-�' i ` I,�`� �-=., <br />NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO <br />BE IN RACEWAYS, MC OR AC CABLE. <br />State/Zip Phone <br />���� �� ��� 11�� �, , ����_ ��,�,�.; , <br />State/Zip Phone <br />Contract Price of Work <br />� <br />Contact Person (Plan Review) <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />: hereby cerii(y thaf I have read and examined this application and kno�v the same to be troe and <br />.:orrect. AU provisions ol/aws and ordinances govemuig this type of work �wll be completed <br />,snether spea(ied herein w not. The granting ol a permit does not presume (o give authonty to <br />: iolate or cancel the provis�ons of any ofher sfate or Iecal la�v regulating construcfion or the <br />oerformance oI consvucLon. That / am authonzed by the owner o/ this propeRy to perform the <br />�vork lo� which applica7ion is made and I cemply �vdh fhe Stafe Contraciors Law '8.27 RCW and <br />296.200 WAC. <br />� � `� � � 1 '� �_ )1 ��Y� �' �� - V �� - �. , � - � <br />� �� �., <br />J\�c� �J�\�:',( �r, <br />FEE <br />/�/ <br />