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( <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 �_ � 7�/p <br />425-257-8810 - FAX425-257-8857—www.everettwa.org �/O�z--1576 <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />�D�C� S �r�?�� � <br />PROJECT ADDRESS <br />K�-�ti�= r�� ����,����� 3 :� ,.� ���o��� s�' ��t;�� ��.�4- �s �h� <br />Owner hlail Address City Slale/Zip Phone <br />'r" ��?.G 5'GnrrYJ�"T G:Vt/�L/�%_lLl�•�%Ff?D/ �h�--1J.1'7 <br />TCnanl A1ail Address Cily Stale/7.ip Phone <br />Eledrical CoNraclor A�aii nddress <br />Slate License Number <br />Proposed Use ol Buildiny <br />Descriplion o( Work lo �e Done: <br />NOTE: W IRING IN NON-D�VELLINGS IS REQUIRED TO <br />BE IN RACEWAI'S, �AC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />city <br />Slate/Zlp <br />Contract Price of Work <br />Conlad Person (Plan Review) <br />1lmreby certily (haf I Im��e read and ea�nnuned fhis application and kno�r the 5arne to be (rue and <br />correct All prorisions o/lan-s and orxlinances govenuny (his type o/u-ork �rill be complefed <br />�vhetlrer speci6ed hemin or noL The �ranfin� al a perrnrt does nof resume fo give �ufhonfy fo <br />violafe or cancel the provisions ol an}� ofher s(ate or lor,nl In�v �e�uPfing consfrucfion or tho <br />perfonnance o/ conslri�c(ion. That I am outhorized Gy fhe ownei of fhis property fo pedonn fhe <br />wod� !or wl�ich applicafion is ntode and 1 cortrpl}� u�ifh fhe Stnte Confracfors Lau� 18.27 RCW and <br />296.200 WAC. <br />,.�— '.Z — <br />Phone <br />FEE <br />� I OOz ' U �{,' <br />