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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-�3810 - FAX 425-257-8857 — wwt �.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />. � <br />�i'c�,�7 y�i� I��-. <br />PROJECT ADDRESS <br />C. ; �� ��'r ��[i �r!'r / �' �� i )'� /_ _ ��-�- `�"!/: ��� 1i <br />� S v i r c .,� � G'r� �'r / t�, J' <br />Owner Mail Address City Slate/Zip Phone <br />�� � c� ., r r <br />Tenant <br />ElecMcal Contractor <br />(,' i�':-r Y[" <br />State License Number <br />Mail Aodress <br />Mail Aatlress <br />(L': I Tr ���r �ri- ��4 ir <br />Proposed Uso of Building <br />City <br />City <br />Descnption of Work to Ba Done: __�G�...,,_�.-,,..:_.,�_..�_. ���,��+- . <br />i <br />; NOTE: W'RING IN NON-DWELLINGS IS REQUIRED TO <br />' BE IN RACEWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />State/Zip <br />State2ip <br />,i G' 00 C� <br />Conlra t Prico o( Work <br />Contact Person (Plan Review) <br />I hereby ceRity that I have read and examined this applicafion and know the same to be true and <br />rorrect. AN provisions ol faws and ordinances goveming this type of work will be completed <br />,vhether specified nerein or noL The granting o/a permd dces not presume to give authonty to <br />�.�olate or wnce/ fhe provisions of any ofher sfate or local law regulafing construction or the <br />peAormance o! construction. That / am au(honzed by fhe owner of this property to peAorm the <br />�vork Por �vhich application is made and I ccmply wifh the State Contraaors Law 18.2i RCW and <br />296.200 WAC. <br />� '�l«� s <br />'. Signature <br />FEE <br />� I�%✓CJZ-(�J�JS <br />Phone <br />Phone <br />