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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREE f,�VERETT, WA 98201 S"�� �6 <br />425-257-8810 - FAX 425-25l-8857 — www.everettwa.org � Q 6 05�1� 'rj <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PROJECT AD�RESS <br />Owner <br />Tenanl <br />,,nFr <br />Eleclrical Conlraclor <br />State License Number <br />Propased Use ot Duildin� <br />Descriplion ol Work lo De Done: <br />Mail Address <br />Mail Address <br />M11ail Addmss <br />l r r.: <br />Cily <br />City <br />Ciry <br />�I �'?OI <br />Stale2ip <br />�I <br />State/Zip <br />State/Zip <br />Conlract Price of Work <br />Conlact Person (Plan Review) <br />NOTE: WIRING IN NON-DWELLINGS IS REQUIREJ TO FEE <br />�E IN RACEWAI'S, MC OR AC CABLE. <br />�� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certi�}� fhat 1 have rend and examined fhis applicati,;n end kno�v (he sarne lo be fnie and <br />correcf. All provisions olla�rs nnd ordinances govenung Ilus fype o( �rork will be completed <br />�rhefher spea(ed herein or noL The granfing ol a pernut does nof resmne to give authonty to <br />violate or cancel Ihe provisions ol any ofhe� state or local l�w reguPfiny con5trucUon or the <br />peAommnce o/ construction. Thaf 1 c�m aufhonzed by the owner of this property to perfomi fhe <br />�e�o�k lor which applicafion is n��de and 1 comply with the State Confractors Law 1827 RCW and <br />296200 4l'AC. <br />�'v V'-% <br />'" " '� /�` <br />�" G.i�� ' <br />Phone <br />i <br />Phone <br />Phone <br />