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ELE�TRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <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 - DEBIT& CREDIT CARDS ARE N07 ACCEPTED <br /> j �,_;' J/a �. j�'/ ��= <br /> PROJECT ADDRESS <br /> U1 � <br /> 7 � Vcn � �,�, �, � r.� „� .; i.� rrl( <br /> Owner Mad Address City Stale.2ip Phone <br /> Tenant Mail Adaress Ciy State/Zlp Phone <br /> ,y . <br /> �i,��' / : " � I��;• �� /��; Y/� �/l�'. <br /> Elecirical Conirac(or V hlml Address City StaleiZip Phone <br /> State License Number Contract Price of Work <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Descriplion ol Work lo Be Dane: ��/ �' t /�,�L-= �-'✓ ���/Y.' f <br /> NOTE: �YIRING IN NON-DWELLINGS IS REGUIRED TO FEE <br /> BE IN RACE'JVAYS, MC OR AC CABLE. ���- <br /> �-/ <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> I hereb��certJ: !haf '!N1va retiA dntl erarn�neA(his appOca6on and know the same to be tlue and <br /> �orrec(. All pic���siqns ol laws anU artlmances guvemmg(his tvpe ol work wdl be completed <br /> whefher specd�ed here�n or ne1 The grEm6ng ot a permrt voes nofp resume fc give aurhonty to <br /> v�o�are or r.ancei fhe orov�s�ons oJ any ornei srate or�oca�iaw regulatmg consfruction or the <br /> periormence ot cons�ror.tion. rhef I am authunzed by the uwnei el this property fo peAorm the <br />, wo�k lor which appOcaf�on is made ano 1 carnply wdh fhe Sfete wnfracfors Law 7817 RCW and <br /> 296.200 WAC. <br /> �f.'_/ �/// C�""� � +�/�r/US' <br /> i^ <br /> 5�ynawre �;- / Daie � <br /> .%U� '�J�O� <br /> � <br />