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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 �EDAR 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 />�� i� �� �L� ��� � l� �v'� � <br />PROJECT ADDRESS <br />;�/ �k i • - <br />Owner <br />Tenanl <br />„L�i7T�i-7� y,,�t�/.— —��cJ <br />Mail A dresJ S <br />M�il Address <br />/l/Or'�/ //� /i�r�! ���• �/"i <br />Electrical Conlraclor Mail Address <br />Stale License Number <br />Proposed Use o( Building <br />City <br />Gty <br />Cily <br />Description a( Work lo Be Done: L�� ✓-C r��P (� /�� �"'� � <br />NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO <br />BE IN RACEWAYS, MC OR AC CABLE. <br />State/Zip <br />State/Zip <br />Sta�elZip <br />Contract Price of Work <br />Contacl Person (Plan Review) <br />CITY OF EVERETT LOCAL SF.LES TAX CODE IS 3105 <br />I hereby ceAily fhaf 1 frave read and examined this applicafion and hnow the sarne to be true and <br />conecf. All provisions ollaws and ordinances go��ec�ing this type ol work �vill he completed <br />whefher specilied herein or noL The granfin� oi n permd does not resume to give authority to <br />violate or cancel the provisions olany other slale or local law reguPfing construction or!he <br />perlormance o(construction. That 1 am authorized by fhe owner of this property to peAorm Ihe <br />work lor which applicatien is rnade and 1 comply with Ihe State ConVactors Law 18.27 RCW and <br />296.200 WAC. <br />� <br />? , <br />;�„r �: <br />,}? � �Z'O i'c:: <br />FEE <br />% <br />%�/� J _ �i, <br />J <br />Phone <br />Phone <br />Phone <br />