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ELE:CTRICAL 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 ACCEPT[D FROM B AM TO 4 PM <br />�'�l - ii z'' �T S� <br />PROJECT ADDRESS <br />l_,�w.c � � �al� � �- <br />Owner Mail Adaress Clty Staleilip Phone <br />Ten2n1 <br />Mail Address <br />n <br />EI�Grical <br />Mail Address <br />�',�� \ c-�Z Oo $ .S � <br />State Liconse Number <br />�,e.. �� <br />Pro�:os d Use ol Buildin� <br />Stale/Zip Phonc <br />y2s. ��c �3ro <br />Slale.2ip <br />� <br />�{$1. <br />Contract Prico ol Wbrk <br />Contacl Persun (Plan Review) <br />Phone <br />Description o� Work lu Be Don�: V.tiJJ� 'e X� S�'`^ 1c �.O l�-. c eT '� 0�'Q ____ <br />� "T V1 Q�••S �i O �-i. <br />NOTE: WIRING IN NON-DWELLINGS IS RFOUIREU TO <br />BE IN RACEWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br />I hereby r.��rtJy thaf I have read nnd ezarruneAfhis nppl�cnfion end know Ihe same to be Irue anA <br />rorrocl All prowsions nllnws �nd o�dinan�:es governmg flus fype o! work will Ge carnplefed <br />whether specihed heroin or noi. The granting ol e pornnf does nul Firesume lo give a�dhodty fo <br />wolafe w cancel fhe piovisions ol eny ofher sfafe or local lew regula�inp cons6ucfion or lhe <br />performmice o! conshucfion lhaf I eim ��ulhorized by fhe ownar o/ fhis p�operty to perfonn fhe <br />work lur whlch appLct�Gun is m,aAe and 1 comply wifh the State Contracfors Law 1A.27 RCW and <br />29G. 200 WAC. <br />�/2b./IL <br />FEE <br />FL%��'3 -/ � � <br />