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ELEGTRiCAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.evereltwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />�" j�'� ('r j i �,'t� <br />PROJECT ADDRESS <br />O�vner <br />Tenanl <br />- ,; ,.,, , :� <br />Mail Address <br />M�il Address <br />Electrical Conlrador Mail Address Cily <br />,.��-n��`��IPn iin����) <br />��; � <br />S±ale License Number <br />�� :, � , � r" ��� ��� �� � ,� r <br />Proposed Usc of 5uildin9 <br />(� `I��°I <br />�o�ob-oa2 <br />StalclZip <br />Stale/Zip <br />, F2Li <br />StalelZip <br />� i oon`� <br />Contracl Price of Work <br />Phcne <br />Phone <br />'-i�7" �V ' � <br />_ `, ) � <br />�� ���� <br />�-��'--�-�11,a � � N n r�1 <br />Conlact Person (Plan Review) <br />, � ;; ;;, - �-, �,>�," -rL� 3�v �9'1n P <br />Description of Work lo Oc Donc: ��-,�''_L_i�l.J-�f1�_�� � 1- �L--� <br />NOT[: W IRING IN NOIJ-DWELLINGS IS REQUIRED TO <br />E3E IN FtACEWAYS, MC OR AC CAE3LE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby certi(y tha( I have read and examined fhis application and kno�v the sarne to be true and <br />correcL All prqvisions o(laws and ordinances govertung fhis type olwork will be comp/efed <br />�tihefher spec�6ed herein or not. The granting o( a perrnrt does nof prosume to give aufhonty fo <br />violafe or cancel the provisions o/ any other state or loc�l la�v �ec�ulafmg construcfwn or fhe <br />per(ormance or consfrucGon. That I arn authonzed, by the owner of this propert}� fo ��rlorm the <br />work lor which applicafion is made and I comply �vdh the Sta(e Contracfors Law 18.27 RCW and <br />296.200 WAC. <br />�, <br />� <br />� � -� � � �i 1 �j / <' _ <br />I l �� � ��-- �,,,, i I, � <br />� � �Sign ture Da�e <br />FEE <br />�r _ <br />. __...�yy - - � : <br />