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i <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <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 />. <br />'� ��f — <br />�%�-f % 7��✓� 5� <br />PROJECT ADDRESS <br />S� �(( <br />Owner <br />�.i <br />Tenant <br />�, i Y�u� �� �v- <br />Eleclrical Conlraclor <br />Mail AddresB <br />Mail Address <br />L,Util,n�, ,�- <br />G /%�G'` %L �/ 2 z /��S <br />Stale License Number <br />Proposed Use o( Building <br />Description of Work lo Be Done: <br />�: <br />A4:,ii �ddress <br />,,,���; ll � <br />NOTE: WIRING IN NON-DWI:L.LINGS IS REQUIRFD TO <br />BE IN RACEWAYS, NC OR AC CABLE. <br />CITY OF EVE.RETT LOCAL SAL�S TAX CODE IS 3705 <br />Clry <br />City <br />✓r��-`�k✓� <br />Clty <br />�i`J�i'. �/ � �� � <br />Stale2ip Phone <br />r � <br />Stale2lp Phone <br />�� <br />State/Zip <br />�z33 �-yz�_, <br />� �. <br />� <br />Contract Price uf Work <br />C���• ' ��y'��L���i � <br />Contact Person (Pian Review) <br />I hereby certi(y fhat 1 have read a �d examined this applicafion and know the sama to be truo and <br />rorrecL AI� pravisions ollaws an i ordinances c�ovemmc� fhis typo o/ work will be completed <br />whether specilied herein or noL 1'he granfing o( a permit does not �resuma to �ive authoriry to <br />viola(e or cancel the �rovisions o`any other sfate or local law regu�ating consWction or the <br />perlomiance of cons(rucfion. Th�tt 1 am authonzed by Ihe owner o� Ihis property fo pedomi ihe <br />work lor �vhich application is mace and 1 comply �vith fho State Contractors Law 18.27 RCW and <br />296.200 WAC. �� <br />�i,� - �- z <br />FEE <br />Phone <br />' l uY_ ln /- c; /c'�. <br />��,��'�'1 ����� <br />