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o,� oi ��nii ia:,s r:�� 11i0115JD4Js c:�ucis i:x•r inc <br />ELEGTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 982P1 <br />425-257-8810 - FAX 425-257-8857 — www.evorettwe.org <br />APPLICATIONS ARE ACCEP7ED FROM 9 AM TO 4 PM <br />�y7 X>"-�� �� �� <br />PROJECTADDRESS <br />Owner Mdl Atldrou Clty <br />.�����1 '�' <br />[lodricai Contredor <br />Mell Addrou <br />�i � ./ i <br />�y-�. ✓y �".7(a l �/ <br />/ . ad Adaren <br />�J/�/L �i !'� /� /"9 �!' , 1 <br />State Llcense Number <br />�4' <br />�. . , f . , . �_- <br />Prupoaad Uee o( Bulldinp <br />Deecnptwn ol Work to Ba Uono- ,,, � <br />9 <br />NOTE. WIRING IN NON•DWELLINGS IS REOUIRED TO <br />�E IN �.ACEWAYS, MC OR AC CARLE <br />-z✓ <br />� <br />Clly <br />Ciry <br />�joni noi <br />sroiaz�P Pno�o <br />�/�'.�iu� i��}Cj-- <br />� �.:. L '.� ° r x'u — <br />51 WZip Phone <br />.��'Y' G—�J <br />:� L�i Y,>)�7,71 /�'�+':•�� <br />� Sute2lp Phone <br />� �,�,Y <br />_u�j i/i� <br />Contrect Price of Work <br />�1_Sf�4[, C'/i^.I)4',icl�.-, <br />Contect Peroon IPien Rovlew) <br />CITV OF EVERETT LOCAI SALES TAX CODE 19 J106 <br />I AemG7 certify Ihat I haw reod ond exominetl fhis apUocotlan and know f�e seme lo �o frue and <br />irrr[+Cf All prowslens o/ laws nnd ord�nanpos Govemmp fhrs typo e! worlc wtll Dn mmplefod <br />wnothor SpeaBed herom rn n;�� TIrA pmnfinp c!a Oermd tloes not F�sume fo p�ve euthonry (o <br />��rMeto or cancel tho �vws�un� ol eny ofhe� stnfe or locni �ew n 7uiahnp r,orsttichon or fhe <br />porlo�manCo c1 consPrucf�on : naf I am ouVronred by Ihe rnonnr u( f�is pmperfy lo podo�m fhu <br />work lcr whiCh epclicnhnn �5 matlo Ond f Compry wifh !ho Sfale ConhaCfors Law 7B i7 RCW and <br />.96.700 WAC <br />� <br />FEE <br />;1 � � <br />c < <br />�� ��' �.�� _ � <br />