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ELECTRICAL PERIVIIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — ww�n�.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />.� - `' � � <br />PROJECT ADDRESS <br />�i l�'1 ��IC�S�-�� )2Z4 Ia �I-I.��_ C; Sti� �L�I,�Ltlicu f,� i� �Id� Z7_J <br />Otvner �Aail Address Cily Slale2ip Phone <br />Tenanl <br />A1�il Address <br />Cily, <br />Slale/Zip <br />Phone <br />�nJ I R- i Iv' S ���� r''- I'� L� 6 k: f�! ��` <br />Eledrical Contraclor Fn�i� AJJres; rity StatelZip Phone <br />�� L.j� i�1 C �j,� nl %� ��� D �v'ti� �� <br />Sfale License N.un�i ,�cr <br />` <br />i <br />�� V�Z` ��� � I� <br />Proposad Usc uf Bu'dding <br />Descrip�ion ol Wor4, lo I?c pon��: <br />NOTC: WIRING IN NON-DV1�[LLINGS IS REQUIRED TO <br />BE IN RACEWAI'S, �v1C OR AC CA[3LE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />Contracl Price of Work <br />Conlacl Per;on (Plan Reviewj <br />1 heroUy certily thaf i hare read and exarnined this applicalior. and know the same to bo frue and <br />correcl. All pruvisions o( laivs anA ordinances governing this t}�pe of work will be crompfefed <br />�rhether specdied l�cvein cr noL The c��antiny e( a pernuf does not iresurno fo yive auflionfy to <br />violate or cancel Uie provisions o/ aip� other state er local Imt regulefin,q consfniction or the <br />perfomiance o/ construc(ion. Th�+f I am &idhorized b}� tha o�tiner o/ this properfy fo pe�lorm fho <br />�vork !or which appli afion is made and I cornpl}� ui0: the Sfate Confracfo�s La�v 18.27 RCW and <br />�d6.200 Vl'AC. <br />� � l...l' <br />r� �r� r �, <br />�~ _---- . -- <br />FEE <br />