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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES ;_ a���; <br />3200 CEDAR STREET, EVERETT, WA 98201 �, � <br />425-257•8810 - FAX 425-257-8857 - www.everettwa.org ` U'�03- � z <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />/ �a� � �' %�`� ��'� <br />PROJECT ADDRESS <br />('� � lt,�-r� �-.� � y�� v <br />Owncr Man Adoress <br />Tmmnt ht:w Andmss <br />�('�Q.11�Cs /;!'L. E%� � �` <br />% _ �'o2�f <br />Cdy <br />Cily <br />�;,�f��v <br />C-locirical Conlraclor �tail AAdress City <br />�1�� �'�5'� � � Z2 ��' c� <br />Swlo Licensc Numbnr <br />Propos�d Us� ol Buildmq <br />Doscription ot Work to �e Done: <br />� , <br />� -t � -vr(,t_i l S � <br />�L <br />NOTE' WIRING IN NON-DWELLINGS IS REOUIRED TO <br />OE IN RACEWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br />si,�erz�� <br />S�ale/Zip <br />Phone <br />Phone <br />Slale/Zip Phone <br />��= n2 �--� ��� <br />Contract Prico ol Work <br />Contact Person (P�an Reviaw) <br />/ 2�� SQ � <br />, . _. <br />1 herrby ce�itAy thaf I hrrve� maA nnd oxarmned Ihis ri�rp6calron �nd knaw the sarne lo be hue anA <br />conecf All provisrons u! len:s tvnd orJmune��s yuverninq Ifus type o! �vork wdl be complefed <br />whefhe� spoe�6i�d heicin or nol Thc grnn6n� ol e pennd Aoes nof neswne to give eulhonty fo <br />�dolafc nr cancel (he Ivovisions o! any olhw sfato o� local Inw iepulefing r.onsfn�ction or fho <br />perforrnance o! coi sh c0on Thaf 1 arn aiAhorizeA by fhe owner o/ fhis property to perlom� the <br />worF !or �chich ��pp`ica�i�,js madc and I cornply wlfh fhe Slalc Confraclors Lew 18.27 RCW and <br />29G2UO,NMIG� �I �. <br />I � �, �� � / <br />� � ����� <br />�,��'�� �) =- (?' �� ` <br />-- •' -- ' . <br />FEE <br />