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ELECTRICAL PF'RMIT APPLICATION <br />CITY OF EVERET'T PERMIT SERVICES �-` <br />3200 CEDAR STRf_ET, EVERETT, WA 98201 <br />425-257-8810 - FAXa25-257-8857—www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />PROJECT ADDRESS <br />c _ ����C� A ��. �-�� <br />I�e��- �?�� c��-�� <br />_ , <br />��n�4-�`, � �; � � c ��� <br />Ownef I Mail Addres5 <br />c vc<�n.�'�� ��tV-,��..�-�in <br />Tenant Mail Adnress <br />Electrical Contractor <br />Cily <br />n�(Ps <br />Cily <br />�cC��� .��-I;�yll5 <br />Mai; Address <br />�a�N s�� � .�s� �;s Gl -3�- <br />Slale License Number <br />��� Ci w� �Q. ' � t � .5 C �1i1 ;� <br />Proposed Usebf Eiuiltlinc� <br />Description ol Work to Be Done: <br />�/'L i i'� t� r� <br />.i' i r <br />7�cr �% � —1.�� <br />NOTE: WIRIN�; IN NON-DWELLINGS IS REQUIRED TO <br />BE IN Rl,C[WAYS, MC OR AG CABLE. <br />CITY GF EVERCTT LOCAL SALES TAX CODE IS 3105 <br />CU�� �s� �� <br />Slate2iP �� � I P� <br />cr�� ��1� zs2— <br />tate/Zio Phone <br />S� <br />rity�-� Stale/ZiP ��S - 3J(� PhJn�,. <br />� � � �, . <br />/ 2 �' � <br />Contract Price o( Work <br />� �? <br />Contac; Person (Plan Review) <br />I hereby certil/ fh�t / have read and ei.�mined this application and know Ihe same lo be true and <br />correcL All p,ovisions o/Imvs and ordinances yoverning this type alwork will be comp/eted <br />n�hether spesilred hcrein cr ncL The grontinr� o( a pernuf does nol �resume to give authority to <br />vin/ate or cr�ncel the provisions of an}� olhsr stafe cr local law regulafinc� construc6on or fhe <br />perfonnance o/ coi�struc6on. Thaf 1 am authonred by the owner of Ihis properly to perlorm fhe <br />�vork for �vhich application is made and 1 comply�+i(!� the State Confractors Law 18.27 RCW and <br />29G.200 VVAC. / / <br />L��--� -3� / l o' <br />:_ . <br />C� l �CLJ/� <br />FEE i7 <br />r� <br />��7 � J <br />� <br />;� �,; -c� 1 <br />�' <br />(Ti <br />