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ELECTRICAL PERMIT APPLICATION <br />CIT'Y OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everetlwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />/ �7 ��/ �� <br />� i0 %�J�z>zy %L. — <i �-L.��l� .:�— <br />PROJECT ADDRESS <br />Owner <br />I.'�T4t�J/ � <br />Tenant <br />',s�>t<",-L <br />Elecirical Contraclor <br />Slate License Numher <br />Proposed Use ot Building <br />Mail Address <br />Mail Addmss <br />Mail Address <br />Square Footage Q( residen�ial new consiruclion, remodel or addition) <br />Descriplion of Work �a Be Done: <br />NOT[: WIRING IN NON-DW[LLINGS IS R[QUIRED TO <br />QE IN RACEWAYS, MC OR AC CABLE . <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />City <br />City <br />Ci�y <br />/ �s� �7 �i�f=��'v�� <br />SlatclZip Phone <br />Slale/Zip Phone <br />S�atelZip <br />Contracl Price ot Work <br />Contact Person (Plan Review) <br />I hereby ceriif}� that 1 have road and exarnined this ap�lication mid knotv the same to Ge true and <br />correcL All p�ovisions o/ laws and o�dinances govemmg this type of tvork will be comple(ed <br />tvhether speci6ed Oerrin ornof. The gran(ing oI a pemtd does not resunte to givc aufhonty (o <br />violato orcancel the provisions o/any otlierstate orlocallmv reguPting constn�chon or the <br />perlonnance of consiructian. Thaf I am aufho�ized by the o��nero/fhisp rnperty to peilrnn Ihe <br />u�ark (ar ��.�hich application is made and 1 comply �vilh O�e Stafe Cont�actors Law 18.27 RCW and <br />29G200 WAC. <br />� — <br />/ ' / 7' <br />� � Date � <br />Phone <br />FEE <br />L�J � au� - o u� <br />