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ELECTRICAL P�cRMIT APPLICATION <br /> I CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREE f, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEP7ED <br /> � -- � <br /> - , ( � �(i��,i��� ��./,; <br /> � <br /> PROJECT ADDRESS <br /> �4_ ���_t � .� /��� �,�%Oj �_-C .J� T-���1�.1 ��1 ���� � �� �!/'-�� L'i3iJ1���^J <br /> Ownef Mail Address City Slate/Zip Phona <br /> Tenant Mail Address Clty Slate2lp Phone <br /> �'�U�1P1�� �� i� fl��-�';s' <br /> Electrical Contractor M.tl Adtlress City Slate/Zip Phone <br /> ��' y0 C� <br /> State License Number Conlract Price of Work � <br /> �� / <br /> ( `�Y L! !J:�L7ct Lr' � <br /> Proposed Uso of Duilding Contact Person (Flan Reviow) <br /> Descriplian ol Work to Be Done: t � I i„ �� �/�� (, n �l l ���v� �l C ( � ��'I<> <br /> i <br /> NOTE: WIRING IN NON•DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWr�Y i, MC OR AC CABLE. <br /> I <br /> � CITY OF EVEREl7 LOCAL SALES TAJ(COOE IS 3105 <br /> .. f hereby�certJy toat I have read and exammed th�s appiicafion and know the same to be hue end <br /> icerrecf. All prcvrsicns ol laws and ord�nances govemmg this type ol work wd!be completad <br /> whether specihea herem or noL 7he gren6ng ol a rrrmrt does not presume to g�ve authority to <br /> v�olate or cancel fhe p�ovisions ol eny other sfate ,i local law regu/ating construcfion or the <br /> performance ol cvnstrucfion, 7hat I am authonzed by the owner o/this propeRy fo perlorm the <br /> wcrk 2r wh�ch application is mada �l comply with fhe Stafe Contractors Law 18.2i RCW and <br /> 96 200 WAC. <br /> � � . <br /> ' / <br /> � __%��=•.� i %�C i�'S- <br /> S+y .aWte ' Dale <br /> I � 05�1 ' �al <br />