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L� Sc� ��3 <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 �� a. l-I Z <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org C-�2a a_�� 7 <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />l 3 �l o a���� ��f ���.� � <br />PROJECT ADDRESS yZS _ 37� �� <br />Owner <br />Tenant <br />Mait Address <br />s cwne_ cc� �- <br />Mcil Address <br />U. <br />Eleclrical Conlractor Mail Address <br />� � �'1�( <br />City <br />City <br />City <br />� � e c_Tc. � o�.� 6� - <br />State License Number <br />O.� s���� <br />Proposed Use 6uiltling <br />Description of Work to Be Done: <br />NOTE: V'.'IRING 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 />Stalerzip <br />State/Zip <br />Slate2ip <br />� ��� <br />Contract Price of Work <br />Conlact Person (Plan Review) <br />f-- � �� �� c� ' <br />1 hereby ceriify fhaf I have read and exarnined fhis application and knav the same to Ge true and <br />correcL All provrsions o//aws and erdinancas govermng Uiis type ol work will be complefed <br />�vhether specified herein or noL The granfing ol a permd does nofl�resume to give aulhority fo <br />violate or cancel the provisions of any ofher state or local law regu afing wnstruction or Ihe <br />pe�fomiance o(consWction. That 1 am authonzed by the owner o/ this properiy to pedorm the <br />work !or which application is made and I cornply with the Sfate Contractors Law 18.27 RCW and <br />296.200 4l'AC. <br />� � � ������ � �— <br />.r r—_--_ <br />—"— SignaWre Date <br />Phone <br />Phone <br />Phone <br />FEE � <br />5�5— � <br />� 1Z�L 1�� <br />