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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET EVERETT WA 9�201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org 6--a o—o�' <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />��_ �.7GL �� �.l)1 C' �� U-��Ay L l� ��e�T � <br />PROJECT ADDRESS <br />`�0.�w�c� 1��IJ����c_ <br />Owner <br />Il <br />Tenant <br />Mail Address <br />A1ail Address <br />�;�����I� ��E���,� <br />Etoclrical Contraclor i�1un nddwss <br />Slate License Nmnber <br />Proposed Usc ul Ouildinc� <br />ol Work lo �c Dune: <br />l� <br />NOTL: WIRING IN IJON-DW[LLINGS IS REQUiRED TO <br />I3[ IN RACEWAYS, MC OR AC CAf3LE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />�;c � c,��,� <br />City � <br />Cily <br />Clp, <br />Sta�e2ip <br />s�a�e�zip <br />Slale2ip <br />co�oG-ya3 <br />3s�= <br />�gz� � y.��- <br />Phonc � <br />f <br />Phone <br />Phone <br />.0 <br />��L:�: <br />Conlracl Pnco of Work <br />�� ` 1.P1 .�I\S � I:x 'Jr J �%c��� <br />Contacl Person (Plan Review) <br />1 hereby certily fhaf I have read imd examined this applicntion anA know fhe sarne fo be frue and <br />currecL A!I provisions of laws and orAinances �overnmg this f}�pe oI wak �rill be cornplefed <br />whether spealied herein ar not Th� granting o/ a pemuf does no( �iesume fo gire authonty fo <br />violala or cancel the I�rovisions olany olher stafe or loc.�l ln�v regulafing construchon or fhe <br />perforrnanc��` constiUcfion. Thaf I am aufhoiized by fhe o�rner o/8iis property to pederm fhe <br />�vork lor �rincff app/icafion is ntade and 1 cornply u�itli the Sta(e Centracfors La�r 78.27 RCW anA <br />29G.200 N�AG. / ; <br />i � i i,. <br />I .e,<11+ � _ � �G�J �::�fC,��� -- <br />���� b,����,��CvS <br />FEE <br />i� �Y; C; �- l C � <br />