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, <br />-------i <br />ELECTRICAL F'ERMIT APP� ICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVC?ETT, WA 9F12U1 <br />�',25-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 f'REDIT CARDS ARE NOT ACCEPTED <br />�-------- - ---------------- — <br />i" <br />L 3 ��.i-.��;� � 4 J -�, ;,. <br />FROJECT ADDRESS <br />Owner <br />ienant <br />'� dg �'/ s� <br />Mail Atldres: <br />Mail Address <br />ConVactor Mad AJdress <br />i <br />r��<<.��r�'�j'��.�� <br />I�te LiS — cense Number <br />Praposed Use of �uildir9 -- <br />Dascription o( Work to Be Oone: �� <br />NOTE: WIRING IN NON-DWELLINCJS IS REOUIRED TO <br />BE IN RACEW'AYS, MC OR AC CABLE. <br />CITY Of EVERETT LOCAL SALES TAX CODE IS J105 <br />9� � �l�r- p�o / G.�o <br />State;Zip <br />S�a1C/Lp <br />rnone <br />Phone <br />;��.(I�� 4���� �/�-t=��-��'i� <br />�'Y Slate2iP Phone <br />Conlract Pricy. of Work <br />Contact Person (Plan Review) <br />I hereb,� ce�tdy fha� l hnvd re�a�l anii ext�mrnad flus applicn6nn and Annw fhe same !o be !rue antl <br />eevec( All provaions ollaws a��d anlnrances r�ovmnury fhrs fype ol work wrll he complefed <br />whefher specd�ad here�n or nof The gran6n� ul a permrt d�es not {uesume to y�ve nufhonfy to <br />vinlah� or cencel the piovisions ol a�,y ofher sfafe or Incal law regula6ng cunslruchon or (he <br />peitr, �rniirce ol consVuction r ial I am aufhonzed by the owner u/ fhis property to peAorm fhe <br />n� nk lcr r�hich applipgtion �s ade and I comply wdh fhe Sfete Contractors Law 1B.2; RC W and <br />19ti 240 'vYAC. // <br />�� <br />� ' " ��'_� <br />Uate <br />FEE <br />(/�.' � 7% <br />�_. . � 'i'� � <br />