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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT FERMIT SERVICES �_�-� _b�O <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org � d�j p� —�6� <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />��c� ��<<��u/� iAilC <br />PROJECT ADDRESS <br />�J�szn�'C�ziyzs,�n 3.�v I�N�.��.,�k <br />OwnCr Mail Address <br />Tenanl <br />(�ositive F_I���r-�� <br />Eleclrical Conlractor <br />Stale License Numbcr <br />i" Q W ��Um� <br />Proposed Usc of Buildin� <br />Description o( Work lo Be Done: <br />Mail Atldress <br />Atail �ddmss <br />NOTE: W IRING IN fJON-D\NELLINGS IS REQUIRED TO <br />f3E IN RACEWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />E�e�z1t <br />City <br />City <br />Cily <br />t✓�, �( �f.2�3 <br />SWte/Zip <br />Slale/Zip <br />StatMZip <br />Coniracl Price of Work <br />� <br />Contact Person (Plan Review) <br />FEE <br />4� 5 - 3sv <br />� `io� <br />Phone <br />Phone <br />Phone <br />1 hereby cmlil}� thaf 1 have read and examined this application and know the sarne fo be tn�e and �_��•] <br />correct. All piu✓isions ollmvs and crdinances �overnmg Ihis t}�pe o/ work will be complefed L�.V L <br />whe(her specdied he�cin or noL The granfing o/ n pernuf does nofl�resume to give aulhonty fo <br />viola(e or cancel fhe provisions olany other sta(e or local law regu afing con56uclion or (he <br />paformance o/conshuotion. Tl;at ! am aulhonzed by fhe owner oRhis property to perforrn fhe <br />wo�k lor �vLich applicafion is ni�dc anU 1 cornply �vifh Ihe Statc Conhactors Law 78.27 RCW and <br />—,(-r- -_.- . <br />� } 0��`��. \� � <br />`�� SignaWre <br />� <br />',��.� y - ! � - �(� <br />