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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CE:JAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPYED FRUM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> �I�� /I' C%r/�C/_' /✓l/f' L�����1"'T y���/ <br /> PROJECT ADDRESS <br /> / / <br /> li <br /> , ; � f� �'�/ i,�•� � ��.; � <br /> � �1 <br /> � .Y / qy�^-C.�,nl /"�v� �'��f,'� �/�/�,��/Sl 5 Cd <br /> Jwne� Mai Address City S:a;�2ip Fl�one <br /> � `�� `f�C,/2 <br /> Tenant Mail Address Ciry State2ip Phone <br /> �����'/I'�� i� 'h ,�-, : it �: �. <br /> Eleclrical CoNraclor Mail Address Ciry SlatelZip Pnone <br /> State License Number CoNract Price of Work <br /> � I <br /> ✓ � <br /> Proposed Use oi�uilding Contact Person (Plan Review) <br /> Description of Work to Oe Done: �� � �� i � �- � �� � �,., , � , „ . ,� , . �, •�. ,. ,' <br /> q �� - ; i_ � � , r i ���.�. �:�� <br /> NOTE: WIRING IN NON-DWELLINCiS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. `�)T _ <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby cmiily thaf I have road and ea�arnined fhis application and kno�v Ihe same fo be true and <br /> conecl. All provisions o/lau�s and ordinances qovernrng fhis lype ol work will be complefed <br /> whclhcr specilied herein or nof. The granting ola pennrt does nol Presume fo give aufhority fo <br /> violate or cancel fHe pro��isions oI any ofher stale or iocal iaw reguating consfniction or fhe <br /> pedormance oI construction. That 1 am aufhonzed by fhe owner of this property to perform fhe <br /> work Ior which applicafion is made and I comply with the Sl3fe Confracfors Law 1 B27 RCW and <br /> 296.200 WAC. <br /> " ' ' ` /' /� <br /> , .. - <br /> - ��!/�'�'% i r� �l'�m' �- /5-•�� 5 <br /> Sig ature � ' Dale <br /> I .�� -/j S <br />