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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 ��" �� � <br />425-257-8E+� - FAX 425-257-8857 — www.everettwa.org �O6 �/,.rj� 3 <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />� i; � � �/:' �_ r I"; �, r � l <br />PROJECTADDRESS <br />_ , , L ) <br />� t l� _l )�yI'I�`,' IGI�I,i���C< <Ic�t �-�i'/��C!' ��'f� <br />—a` <br />Owner Mail Address City State/Zip Phono <br />„�"'(. <br />Tenanl <br />Moil �ddross <br />Ciiy <br />SlafelZip Phona <br />��-l� S``>'r,.i-�, �')i'2 he' li7'�� l:C"a������C �� J`i�c�� �ir•�c,�i��: <br />Eledrical Conlraclor Mail Addresc City StatelZip Phone <br />L� �' `>` ��] -X c L C G�� � <br />State License Number <br />l � f��( 1�C �i <br />Pmposed Use of Building <br />Description of Work lo Be Done: � " �� l�� � ' ' �� '�' <br />NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO <br />BE IN RACEWAYS, MC OR AC CADLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />ConUact Pnce of Work <br />,_ , <br />I,��l i°f�iGi� <br />Contact Person (Plan Review) <br />I hereby certily fhal 1 have read and exarnined fhis applicafion and know (he same to be frue and <br />conecl. All pmvisions ollaws and orAinances gaveming tAis type o/ work will be cornpleted <br />whether specilied herein or noL The granfing ol a pemut does not resume to give aufhonty to <br />vioiafe or cancel fhe provisions ol any olher sfafe or local law requPfing consfniction or fhe <br />perlonnance ol consiniction. Tbat I am authonzed by (he owner o/ (his property to pedorm fhe <br />wo.k lor w,hich applicafion is made and 1 comply wifh Ihe State Contracfors Law 1827 RCW and <br />29ti.200 WAC. <br />% ,a � 6 � ' � t <br />SignaWre • � Date <br />FEE <br />���ni(-GI j <br />