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ELECTRICAL 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 />APPLICFTIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />� i"' / <br />� � (� � <br />/G %� �� //, ' ';T � <br />PROJECT ADDRESS <br />�� � Y /� ,��Z� `1ZS 7/lr <br />� 5}� ;� �� --_/ �� _il�' _-� �� ��T � <br />Ownef htiilAAdress Cdy State2lp Phone <br />Tenlnl <br />61�d �dAtess <br />Gly <br />i/ <br />� .I./NbYL _ <br />Eleclrical ConUactor A1ail Address Cily <br />Stale Liconso Numbar <br />i1�GY�%Cli <br />Prr,posrA Usc ol BuilAmg <br />Oescriplion of Work lo f3� Unnc�. <br />NOIE. WIRING IN NON-DWELLINGS IS R[QUIRED TO <br />BF IN RACEWAYS. MC OR AC CA6LE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />Stale2ip <br />Slale2�p <br />Conlracl Price ol Work <br />Contact Person (Plan Review) <br />1 hc�eby rerhly flra( 1 h�ve rend and exnrmn��d fhis upplma6on and know fhe same to be true anA <br />i.nua��t All piuvisions ol Inws and o�Avinncns �overnm,y fhis typc of work ivill bo compfefed <br />�vholhnr �peci6ed herein or noL Thc c�rarting ol a pernuf does nof �resume (e givo aufhonfy fo <br />i-iolntn o� cancM th� provisions o! any ofhr,r slate or lor.al laK� re�ulating construcfion oi fhe <br />prAorrnance o! consVuctiu�. Thnl 1 am authonzed bv the owner o! fhis properiy fo pedorrn the <br />N'i�/F IOI t5'IIICII 8/7I)IIf,8U011IS fIi7AC 7!i(I I CO/ll�l!y 11'I�II IIIC Slafe Cnnfrnclors Law f8.27 RCW and <br />29ti200 WAC. <br />��� <br />FEE � i <br />�"J <br />Phonc <br />Phonc <br />. �►Z <br />, � C,�on <br />� <br />