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ELECTRICAL PERMIT APPLICATION <br />CITY OF FVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everetriva.org <br />1-►g-a5 <br />�osa, -o�y <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />aoG� srp�� r��, <br />PROJECT ADDRESS <br />Owner <br />Tenant <br />�"t �/� A �5 i/ �O O <br />Mail Address <br />Idall Atldress <br />Ciry <br />City <br />State2ip <br />State2ip <br />S�'.�2of y�s <br />G./ft 3 z5 -$'3i <br />Phone <br />Phone <br />�y-�T� 3SS-�ba0 <br />�UVaNr F, t�p/E�ec:�/ Sf2�iiCF�S, inl( io5�v mu,��crEu SPFFOWAy�^r�o ,62urc�cr6a <br />Electrical ConUaclor Mail Address City State2ip Phone <br />, ��� -� � — ( % i.% <br />_Ai�vAdcSSSI Pa �/.ao� �u <br />State License Number Contract Price of Work <br />/�F< , o cu r��1 i <br />Proposed Use of Building Contact Person (Plan Review) <br />Description o( Work to Be Done: �N n(_ / �� /i- q��,c' <br />NOTE: WIRING IN NON•DWELLINGS IS r�E�UIRED TO <br />8E IN RACEWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby certify that I have read and examined fhis application and know the same to be true and <br />correct. All provisiau ol laws and ordinances governing fhis type oI work will be comp/efed <br />whether spea/�ed herem or noL 7he granting o! a permd dces not presume to give authonty to <br />vwlafe urcancel the previsions olany efhersfate orlocallawregulating construction orthe <br />peAermance of constructia�. That 1 am authonzed by the owner ol this property to perform fhe <br />werk Por which applica7ion is made and I compl,v wifh the State Contrauors Law 78.27 RCW and <br />296.200 WAC. <br />�/. <br />FEE <br />