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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT f'ERMIT SERVICES <br /> 3200 CEDAR STREET, EVERF_TT, WA 9820i <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM E AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> lJ � � (��.C'cr �1/C� t � � .�of y <br /> PROJECT ADDRESS <br /> �,�n �� �n7ti�ris ti <br /> Ownef Mail Address Ciry State!Zip Phone <br /> Tenant A1aii Address City State/Zip Phone <br /> /�l0 FT/7 `i'�'7 /. i � /I I �/C f. �i'f <_.• <br /> Electrical ConlraClor Mail Address City State/Zip Phone <br /> State License Number Contract Price of`Nork <br /> Proposed Use of Building Conlact Person (Plan Review) <br /> Description of Work to 8e Don•:: �1/'�,P �%�� 4J /7� /'� L. <br /> NOTE: WIRIfJG IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> i hereby certity that I have read and examined lhis application and know the same to be true and <br /> r,enect All prov�sions of laws and ordinances govemmg this type o/work�vill be complefed <br /> whether specilied herein or noL The granting c/a permd Cces not presume fo give authonfy to <br /> violate or cancel 1he provisions of any ether sfate orlecal law regulating consWcfion or the <br /> peAcrmance ol consfruc6on. Lhat 1 am authonzed by fhe owner o/fhis properfy to perferm tYe <br /> werk(or which application is made and I comply with the State Ccntractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> . <br /> ��/� �l��P�//i ' - � �� c��� �� <br /> Signawre �ate <br /> r <br /> � . . <br /> / ' ' <br />