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ELECTRICAL PERMIT APPLICATION <br />CITY OF �tVERETT PERMIT SERVICE;i <br />3"<JO CEDAR STREET, EV�RETT, W!', 98201 <br />425-257-8810 - F/aX 425-257-8857 — www.everettwa.org <br />r?-a7-��( <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CFEDIT CARDS ARE NOT ACCEPTED <br />I011 �S�` � <br />PROJECT ADDRESS <br />� <br />J� <br />Owner � / <br />l 1 �/ <br />Tenant n <br />N��"i� <br />Electrical Contractor <br />S e(--� <br />State License Number <br />�i� �� ��,�F � <br />Proposed Use of Buiiding <br />Address <br />Mail Address <br />64ai1 A.ddress <br />City <br />City <br />City <br />Descriplion of Work to Be Dane: Re � I..n /i� I��/e _ <br />NOTE: WIRING IN NON-DWELLWGS IS REQUIRED TO <br />8E IN R.4CEWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />StatelZip <br />StatelZip <br />Phone <br />360- I6d'-�/3� <br />Phone <br />State/Z�p Phone <br />O� <br />�2r�. <br />Contract Pdce of Work <br />/`'z�l�/ 7e�14.._ <br />Contact Person (Plan Review) <br />L( � � `— �22— ��rG <br />1 here6y certi'y that / have read and examined this application and know the same to be We and <br />correct. All provisions of laws and ordinances governmg this type of work will be comp/eted <br />wnether specd�ed herein or noL The grantirg ol a permit does not presume to give authonty to <br />violate or cance/ lhe provisions oi any other state or local law re9ulating const�uchon or the <br />perfcrmance of construchon. ihaf I am aufhonzed by (he owner of this propeny to peAonn the <br />werk /oi which application is made and I comply with the State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />J <br />FEE <br />