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ELE�CTRICAL PERMIT APPLICATION <br />CITY O(� EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEP7ED FROM 8 AM TO 4 PM <br />���� ���� 5����'� <br />PROJECT ADDRESS <br />3 -{ �—+3 <br />C-►3�3-� <br />�� � -��r ��o�joc� <br />�iPNU Q' �llc+� �u I i � ��� 7 o�,FCad W6Q � � � � l�� �dl�'e?� �%�" %��� ( <br />Ovmer MailAtlaress City State/Zip Pnone i <br />ienanl <br />5�1-F <br />[lectrical Conlractor <br />License Number <br />Propased Use of 13uilding <br />�dail Address <br />Idail Address <br />7j 1 k7 <br />Square Footage (II residenlial new cons�ruclion, remodel or addition) <br />Descriplion of `Nork lo �e Done: <br />—,r�—u�i--f '—� -- / - — <br />NOT[ WIRING IN NON-DWELLINGS IS R[�UIRED TO <br />BE IN RACEWAYS, MC OR AC CACiLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />City <br />City <br />� <br />Slate/Zip <br />State/Zip <br />Conlract Price of Work <br />Contacl Person (Pian Review) <br />r� <br />I heieby r.ertity fhat I have read and examined (his applir. �tion and knowl,hr. snme fo b Gur, and <br />r.onec(. All provisions ollaws and ordinances govemmg Ihis type ol work wdl U�r compleled <br />whe(her speci�ed hcm.in or nol. The q�anfing ol a pemid does nof ��esurnc to qive ;iu(honty fo <br />violale or cance! the provisions ol any othe� s(ate oNor.al law reyul�(ing conshi�r.6on or Ihe <br />pedonr��nce ul consfrur.lion. Thnt 1 arn aufhonred by (he owner ol fhis uupe�ty fo pedomr Ihe <br />wo�klor which appb:afion is madc and I comply wifh fhc Slale Conhaclors l.nv 18 27 RCW and <br />296200 WAC. <br />� �� <br />FEE <br />�so 0 <br />Phonr. <br />Phone <br />� i 3v 3_�g <br />