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ELECTRICAL PERMIT APPL.�C�4TION <br />CITY OF EUERETT PERMIT SERVICE5 <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 />`j" _j 1 /�;� ,;�J CiJ '�� <br />PROJECT ADD � ESS <br />Owner <br />Tenant <br />;i <br />Electrical ConVaclor <br />State License Number <br />Proposed Use of Building <br />Description of Work to Be Done: <br />Mail Address <br />Mail Address <br />Mail Address <br />) <br />(' Gr%�_ <br />NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO <br />BE IN R4CEWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CC:JE IS 3105 <br />City <br />Cily <br />City <br />�� .�y/,l�l C�l� � <br />State/Zip <br />�,.��5� 7s'�l % <br />State/Zip <br />Stale/Zip <br />Contract Price o( Work <br />Contact Person (Plan Review) <br />1 hereby ceAily that 1 have read and examineU this application and know the same to be Irue and <br />correct. All provisions of laws and ordinances goveming this type of work will be completad <br />whether specified herein or noL The granting of a permd does not presume to give authonty to <br />vio/ate or cancel the pmvisions ol any other state or local law regulating construcfion or the <br />pedormance of consfruction. That 1 am authonzed by the owner o/ this property to peAorm the <br />work lor whic6 application is rnade and I comply �rith fhe Sfate Contractors Law 1 fi.27 RCIN and <br />296.200 WAC. . <br />�� <br />FEE <br />y� <br />Phone <br />Phone <br />Phone <br />