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ELECTRICAL PERMIT APPLICATIQ�3 <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.evereltwa.org <br />AAPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />1/�C� �Z-� }� p� S E <br />PROJECT ADDRESS <br />CE7R� I���� iNvF_�i n.^ <br />Owner ata�i �ddress <br />Tr.nant <br />I.fad FdAir.ss <br />Ciy <br />Ci�y <br />Slale2ip <br />State'Zlp <br />Phonc <br />Phone <br />1 C3c.,) <br />�P��� V�,11e� � lec `{`'I� �rncK� `�erl�C�.e�c,�� (�1��� `r'�iLY� 33l,�s �z <br />Eloctrical Conlraclor Mail AAdress Cily Slate2ip Phone <br />�Jl.�,�\�9°�1�1`{ <br />lato Licenso Number <br />C1cs,��,;h'�I 1��,�, <br />Proposed Use of Building <br />Des�rip�ion ol Wor6 to De Dono: <br />NOTE: WIRING IN NON•DWELLINGS IS REQUIRED TO <br />E3E IN RACEWAYS, MC OR AC CAbLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />Contract Price of Work <br />Contact Person (Plan Roviow) <br />v� <br />1 hacby cerhly fhaf 1 bnee iead nnd ex;irnineAlhis epp6cation anAknu�v fhe samo fo be t�ue and <br />r.ormcf. All piavisions o/ la�vs and oidinances guvernmg fhis fype o/ work will Ge completed <br />whefhc� specilird herein or noL The granlin� ol a pernut does nof presurne to give authority to <br />violnte or r,anr.el (he �rovi€ions oI nrry other sfofe or local law �egu/aling consiruclion or fhe <br />perlarrnince ul cons�iucfion. Thaf / am .lufho�imd by Ihe ownei o/(lus property fo perlonn (he <br />woik !or �rhich ,�pplicntion is rnadc and I cornply wifh fhc Sfatc Con6aclors Law 18.27 RC W and <br />?9G 200 WAC. , <br />FEE <br />�aoov03� <br />