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ELECTRICAL PERMlT APPLICAT�ON <br />CITY OF EVERETT PERMIT SERV".CES <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 />��/l� 3� �'' lU L Cv�rzT� c.c)�. <br />PROJECT !•1DpRESS <br />Owner <br />Electrical Contraclor <br />State Licanse Number <br />Propused Use of Building <br />Descriplion a( Work to Be Done: <br />Mail Address <br />Mail Address <br />Mail Address <br />NOTE: WIRING IN NON-D4'✓ELLINGS IS REQUIRED TO <br />DE IN RACEWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />3yi�, �1I��Jc�r� <br />Cily <br />Cily <br />City <br />Slate/Zip <br />Stale2ip <br />Slate/Zip <br />,.(-�—C�% <br />:> <br />C �%C"?_C'.�� <br />O �� <br />Yv� - <br />Conlracl Price of Work <br />Contacl Person (Plan Review) <br />1 hereby certily that 1 have read and examined this ap�li:;ation and kno�v the some to be frue and <br />correct. All provisions o/laws and ordinances govemvig fh�s type o( work wi116e cumpleted <br />whether spec�6ed h�rein or noL The granting ol a pe�nut aoes nof presumo fo give authonty to <br />viola(e or cancel (he provisions o/ an}� other state or lucal law rec�ulating constructron or fhe <br />perfonnance ol construc6on. That 1 ant aufhorized b� Ihe owner o/ fhis prcperty to peAonn the <br />work lor which applir,ation is made and 1 compty .rilh Ihe State Contracfors Law 18.27 RCW and <br />296.200 WAC. <br />FEE <br />�05 <br />Phone <br />G o7vZ-rr3 a <br />Phone <br />Phone <br />