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ELECTF�ICAL PERMIT APPLICATIQN <br /> CITY OF EVERETT PERMlT SERVICE� �� , a�_„ <br /> 3200 CEDAR STREET, EVERETT, WA 96201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org (;lI/I ` ! �3 <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> I �l��� ( �� C� � lh-� �`�`l�P_ �L)� ���5 � /G <br /> PROJECT ADDRESS <br /> ���� � <br /> 1 � � o 11 �� `��r�17 � <br /> �� '�1' �'� �" ��� � � ��L I fi l 1 l � i P� )t �i�YQ. Phon� <br /> Q�yp�� A1ail Address Cily Stale2ip <br /> Tenant <br /> A1ail Address City Slale2ip Phone <br /> Eleclrical Conlraclor Mail Address Clly <br /> State/Zip Phone <br /> Stale License Number Conlracl Price of Work <br /> �� n �I11 <br /> � r��� '"< <��✓ Conlact Person (Plan Review) <br /> Proposed Use o[Building <br /> Descriplion of Work to�e Dono: �� (Jl 1� �'� �� U <br /> � LC.Gt n o(w�o /`� <br /> C <br /> NOTE: 1NIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I <br /> I hereby certify fhaf 1 hove read and exarnined fhis applicafion and kno�v the samo fo be frue and <br /> correcl. All pro��isions olla�vs and ordinances govemmg this type of�rork rvill be complefed <br /> �rftetherspeci6ed herein or noL The����nlinr�o/a perntd does nof presume fo c�ive aufhonly fo // // _ / j <br /> violale or cancel fhe Iuovisions o/any other state or locallaw regulafing consfnicfion or fhe <br /> perfomiance o/censfn�cfiat That 1 am authonzed,by the o�rner ollhis propeny to perform fhe <br /> work for n�hicl applicalion is mado and 1 comply n��th Ihe Sfate Cenlrac(ors Law 18.27 RCW and <br /> 296.200 V✓AC� /1 �- <br /> , ���� "/' i �' ..;�� -p� i <br /> ��f�._( f �j_�����, � l i��Y, � <br /> ' Signalure � � <br /> i <br /> �- <br />