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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />�' `1 � � � `1 i � ��-. `:�, ��.�, <br />PROJECT ADDRESS <br />� ��,�-�vc,�, ���; ��.�o\�tx 1 W � ��„�:1 `}I <br />Owner Mail AcJross <br />Tenant <br />Electrical Contractor <br />Mail Address <br />C,�v �.C, �.c� �1�� � <br />Mail Address <br />',`� ���-� T r..� C L�� r; �� =� �� �', � � <br />Stale License Number ' <br />Proposed Use of Buildin� <br />>'.>.�A G`3Z�� �u2� <br />City <br />Cily <br />City <br />Stale/Zip <br />?y"� - _' �`if' <br />� <br />Phone <br />Stale/Zip <br />v L� �� � <br />Stale2ip <br />Contract Price of Work <br />Phone <br />L��`1� <br />Phone <br />Conlacl Person (Plan Review) <br />Description o( Work to 13e Done: ��J, J �'�Y '�, \; '•" ��,�,. � ��- �� � �-.-� ��� `; <br />NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO <br />BE IN RACEWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />FEE <br />�� <br />I hereby cmiily (hat 1 have re�d and examined fhis applicafion and know the sarne to be (rue and <br />correcL All provisions of laws and ordinancos goveming this type oI work will Ge completed <br />whether spec�6ed herein or noL The granting o/a permd does not prosume fo give aufhonty to <br />violafe or cancel the provisions of ��ny other state or local la�v regulating construcfion or the <br />performance oI construction. Thaf I am autheiized b}� the owner o/ fhis property to perform the <br />work lor which applicafion is made and I comply with fhe Sfate Contractors Law 18.27 RCW and ��� <br />296.200 WAC. <br />, , � � �, <br />� �� �� <br />' ,, ;�, v� � � , -� � ,�,� <br />� l <br />� Signature ' Date i � <br />