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ELECTRICAL PERMIT AF�PLICATION <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 - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br /> , :-� I <br /> ;�-/.j'L .� .:.a7�1 ���� C'� �— <br /> PROJECT ADDRESS <br /> . <br /> �i �����,�-, � / l ��3 �Z��d A�� �� �,-�� ����fi �>d��o� ���� � 5» >u <br /> Owncr A7ail Address City State2ip Phone <br /> Tenanl M11ail Address City State2ip Phone <br /> Ui�srti?� <br /> Electrical Contraclor Mail Address Ciry StalelZip Phone <br /> Stale Licens� Number Contract Price of Work <br /> t ��� t� � ' � <br /> ��>r....ct�_ !—r.r.,�i�� p=.+� � is;'qS.VI l�.-� (�u'1 <br /> Proposed Use of Building � � Contact Person (Plan Review) <br /> Description of Work to Be Done: C�/�'i"-�� �/-4 � ���a l `�.y r�(��1���% <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> � <br /> I CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certify Ihaf I have read and exarnined fhis application and know fhe sante to 6e tn�e and <br /> corrcr.L All provisions ollaws and ordinances r�overnmg this t}�pe o�work�vill be cornpleted <br /> whefhe�speciGed he�ein or noL The granfing ol a pernut does not resurne to give aufhonty fo <br /> ��iolateorcancellhe provisionsolanyotherstateorlocalla�v�eguPatingcon;!n�ctionorthe <br /> perfonnance o/consf�ucfion That I arn aufhonzed by fhe owner o/this property fo perlomi the <br /> work(or�vhich applicalion is made and I comp/y wifh the Stafe Contractors Law f 8.27 RCW and j <br /> 296.200 WAC. �1 <br /> �— <br /> �a � i � l � l <br /> _ /�'�._ ����. ��� �� � .�I�� <br /> Signaturc -��� .. Date � <br /> � i� <br /> � <br />