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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETi' PERMIT SERVICES <br /> 3200 CEDAR STREET, [VERETT, WA 98201 <br /> d25-257-8810 - FAX 425-257-8857 -ww�v.ev?retlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> �- �_r_ ' — � C ( , ��.`.\�. � � x=- +=:�'4�\� � �' <br /> PROJECT ADDRESS <br /> \ l_,'. ��<r_�.-,�- �,�1� •;_�._ - –r.�„ �_' <br /> Ownef ��� Idml Addiess Cdy StatrZip Phcne <br /> Ten2nt I.1ail Address C�Ip - - tiLne'Zi, Phonc <br /> � �T^. '��'D.:�� -�'•.� _ �c <br /> . � � r �r � r' ,c�l`^'"""' � _ W� ' <br /> Eleclrical Coniraclor M1fail ACJress Cdy StatelLp Phone <br /> rr <br /> _ �,C7f'�� .� <br /> �rc.TJ�_'�_ ��1"- <br /> Slale License Number Contract Price ot Work <br /> Propo�ud Use�o� �uildinq Conlart Person (Plan Revic�;�) <br /> Description of Work lo Bc fhmc _ - � - ����' � =-__�_ <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> � <br /> D[ IN RACEWAYS, MC OR AC CABLE. <br /> � <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certity fhat 1 have rcad and examined fhis applicution and kno�r Ihe same fo be true anA <br /> conect All provisions o/larvs and ordinances governin�fhis fype o/n�ork will bc complefed <br /> whefher specdied herein or not The yranfing ol a permd does not resume to�ive authori(y lo <br /> violafe er cancel fhe provisions o�.ny other state or locaf larv reguPfing consfnicfion er fhe <br /> perlorniance o(consWcfion. That I arn aufhorized by fhe oirner ol Ihis property lo perform fhe <br /> work!or�vhich application is rnaAe and 1 c:omply�+ifh Uro S(afe Cantractors Lmv 18.27 RCtN and <br /> 29G.200 WAC. <br /> r <br /> �-C: � � � <br /> ��-Y�,`��--� �� - ��i - �z�. I <br /> SignaWre Date i <br /> I <br />