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►-, <br />LA <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-3810 - FAX 425-257-8857—www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />4 i I <br />PROJECT ADDRESS <br />Qwmer <br />Mail Address <br />City <br />SIalJ2ip <br />Phone <br />_ <br />'1 <br />I" <br />Jl <br />C y <br />W <br />1 <br />i5 _S1- y <br />UC' I f <br />i y I <br />P 1' 1 <br />�1 i <br />{w-o-o <br />Tenant <br />I <br />rOS <br />Mail Address <br />City <br />C'tY <br />SlatelZip <br />Phone <br />rr..um 5 <br />/S-Opz ? 5 j� AV e l,J <br />1yHn 1_1JJo <br />uA 4Bwl <br />415 41-2i <br />Electncal Contractor <br />Mail Address <br />City <br />State/Zit. <br />Phone <br />Eh(E � Gr M4 _LZ R � <br />Stale License Number <br />Proposed Use of Building <br />Square Footage (If residential new construction, remodel or addition) <br />Description of Work to Be Done: <br />NOTE: WIRING IN NON -DWELLINGS IS REQUIRED TO <br />BE IN RACEWAYS, MC OR AC CABLE. <br />�-/z � 0 o .OJ <br />Contract Price of Work <br />d Ic a DU <br />Contact Person (Plan Review) <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby certify that I have mad and examined this application and know the same to be true and <br />correct. All provisions of laws and ordinances goveming this type of work will be completed <br />whether specified herein or not. The granting of a permit does not presume to give aulhodty to <br />violate or cancel the provisions of any other state or local law regulating constmchon or the <br />performance of construction. That I am authorized by the owner of this property to perform the <br />work for which application is made and 1 comply with the State Contractors Law 18,27 RCW and <br />296.200 WAC. <br />FEE <br />