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ELECTRICAL PERMiT AF'PL9�ATION <br />CITY OF EVERETT PERMIT SERVIC�ES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.ev�rettwa.org <br />APPLICATIONS ARE F CCEPTED FROM 8 AM TO 4 pM <br />�y 7-� / /� ,��-� 6cJ ��� — <br />PROJECT ADD i ESS <br />• �i. ! , � � <br />Owner <br />Tenant <br />�) <br />� �"�l�a��. <br />Elecirical Contreclor <br />State License Number <br />A1ail <br />Mail Address <br />Mail Atldress <br />Proposed Use of Building <br />) <br />_- i <br />Description of Work to Be Done: /!__�r % �� w �-!: <br />NOTE: WIRING IN NON-DWELLINf;S IS REQUIRED TO <br />BE IN RACEWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />Ciry <br />City <br />Ci�y <br />G✓/9 `7��"% <br />State/Zip <br />�.?S" %S �/ ��' <br />Slate2ip <br />Stale/Zip <br />Contract Price of l Jork <br />Contact Person (Plan Review) <br />1 hereby certily thaf 1 have �ead and examined this application and know the same to be tiue and <br />correct. All orovisions of laws and ordinances governmg fhis type o( work will be complefed <br />whether speciGed herein or noL The grantinc� ol a permit does no; resume to give authonty :o <br />violate or cancel the provisions o!any ofher stafe or local la�v reguPting construchon or the <br />peAormance o/construchon. That 1 am authorized by the o�ti�ner o/ Ihis property to perlcrm tne <br />wo�k lor which applrcation is made and I comply with the State Contractors Caw 18.27 RCW and <br />296.200 WAC. , <br />FEE <br />Phone <br />Phone <br />Phene <br />