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.�4 ,.y��.. <br />'}yY'' :;�i. <br />'.N!l���i' . <br />:./f;y.,�- __ <br /> x h'A+'� <br /> ELECTRICAL PERMIT APFLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> - 425-257-8810 - FAX425-257-8857—�niww.everettwa.org <br /> ^�`";'�" APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDiT CARDS ARE NOT ACCEPTED <br /> �;, <br />��:.. <br /> C �'•�t � � =/ C,<— �.�(.r��� �j : � <br /> PROJECT ADDRESS <br /> Owner Mail Address City Slate/Zip Phone <br /> Tenant Mail Address City Statc2ip Phone <br /> ��N 1��.U�� I � r i It �. <br /> Electrical Contractor Mail Address City Slate/Zip Phone <br /> Slate License Number ConUact Price of Work <br /> Proposed Use of 9uilding Conlacl Person (Plan Review) <br /> Description of Work ta Be Done: <br /> NOTE: WIR�NG IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 <br /> 1 hereby ceRi/y that 1 have read and examined this application and know fhe same to be true and <br /> correct. All provisions oilaws and ordinances govemmg this type of work will be completed <br /> whether spea�ed herein or noL The gianting c/a permd does not presume lo give aulhonty to <br /> violate or cancel6ie provisions c/any otherstate orlocal law regulating censfruc6on or the <br /> pedormance o/construc6on. That I am authorized by the owner o/this propeRy to perform the <br /> work)or whicb applic;�fion is made and 1 compty wifh the State Contractors Law 18.27 RC W and <br /> 296.200 WAC. � <br /> // /// i� <br /> / /` ' --7 �/ �' � L��� <br /> Si alure Date <br /> � <br /> , �L�L � 1� �/ <br />