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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 />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />.a �� � � L ��/ i ]� S !.� � �i'f ,7, <br />� �, <br />PROJECT ADDRESS <br />l. � , �,-�- --1-=- 1:'—f �_�_ � <br />OWnei �.Lni I���dicss <br />TCf1Bi11 <br />/� �C' � ��I // <br />Eloclrical Conlractur <br />Slate Liconso Numbcr <br />Proposed Usc ol Ouild�ny <br />� �.�J:� %u�l�l�" : <br />Address <br />Ctly <br />Description ol Wor�. to Cie June: �� /"[. /;�! L✓ �;�- _;�,'c <br />NOTE W IRING IN NON-DW [LLINGS IS REOUIRED TO <br />L�[ IN RAC[WAYS, A1C OR AC CABL[. <br />CITY Of EVERETT LOCAL SALES TAX CODE IS 3105 <br />Sta1NLp <br />$�.IIGQI�I <br />Stalc/Zip <br />Con�ract Price ol Wor4. <br />Conlncl Pcrson (Plnn Itovicw) <br />I liorrby certdy fhnf 1 have road and examineJ fhis npplicn6on anA 6nuu� the snnm fo b� tnic anil <br />rnnecf. All pr��dslnns of lan s rmd oiiimnnces �7overnuir� (his type o! �vork wtll be cornplefud <br />�rh�dhrr specilicJ hemin or nof. Thv gr.anfmg ol n pornuf does not nrsurne W give a�dhonl� N <br />ci,Jafe n cuicol fhe �ro��isions ol nny ofha sfafe or locnl la�v regul�tinp consUuc6orr or the <br />pe�forniance o! cons�rucfion Ihal I am nufhori�ed by Oie owne� o/ this properiy fo po�form fhe <br />�ro; 6/�v �+hich application Is made nnA I comply �ro�ilh fhe Stafe Contracfors Law 18.27 RCW anJ <br />7Pfi Z00 W/�C. <br />/ . � � <br />t�.� / ��' � /�i �<%/. <br />— " S�gnelure � � DB <br />. <br />FEE <br />�� <br />��.�> <br />1 <br />Phunc <br />r�1011n <br />Phunc <br />