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ELECT'RICAL PERMIT APPLICAY�ON <br /> CITY OF EVER�TT PERMIT SERVICES <br /> 37.OD CEOAR STREET, EVERETT, WA 98201 <br /> 42525%-8810 • FAX 42�r257-8857—www.everettwa.org <br /> APPLIC,4i10NS ARE ACCEPTED FROM 8 AM TO 4 PM -UEBIT d� CREDIT CARDS ARE NOT ACCEPTED <br /> t-�� 452�J 3?x1�.n�I PtnJ I.�VI ��/"i` �/1� ��� <br /> PROJECT ADD SS <br /> U.�v , �� �Q s�i'11_t1�1 �{442� 1����w i,rl F V��_!hi' vvft- �'1,g.7O� Gh ti��%7ch.�-f q�g�L <br /> .r MaIIMl�u CM StnlNZip Phone <br /> �t�1n.� - <br /> 7enam MO11 AdOR�S Cny Stmerzip Pnone <br /> C;yyti�1� Y�.fy�l�f�rhz Yt1����,i GaN !'G� �S�dlcivv5y� Ln,R- ��ri�10 a(7���f7-03�°7 <br /> [IeUrtcal COrrir»clor MellAdd�e GN tta«T �°^B <br /> �.��n,IN � I Gl (�hr l� _ `���''17' QG —„ <br /> State Lior.n:,c Numbar Contract Price of Work <br /> jZ�<,�' ,1 in-t-I�. i �� i��-fT-S.r-r��t .�l�l�_ <br /> Proposed 115e e}PuilAin� Contad erson (Plan Review) <br /> Desr.nptlon of Wurk ro Or,bone .�P�(•� ��(�6t��lI V 1 GF /,f 6�/.r ��l 111�? <br /> l'lc{" �,-��irf=LY_�{Z�11�_�f�YC'�.I_i =i- - <br /> Nc�TF• WIRING IN NON-DWFILiNGS IS RF�UIR[D 70 FEE <br /> BE IN PACEWAYS, MC OR/1C CABLE. <br /> CI7Y OF EVERETT;.00AL SALES TAX CODE 19 3105 <br /> 1 here6y CortAy th,�t 1 hav«rond rmd aramine�l thls appfrcahcxr and knr,u�tAe samn to bv vue und �:(j 1�=�`C -1 � \ �> <br /> mfteCt NI provisia�5 o/feWs ernl ordirllnCOs goNrmmg thi9 ry{)E ol wak will h9 COI�1pIUtOd <br /> whed�r.r s�u.r.�i�od hurein Or nrd m��n�nr���nr A n�rm�r daes���r�,msumo to p/ve authorlry to <br /> olnla(e w wn�e:l d�e pmnsrons ol nny othnr sfa(e w u,en!l�w rW,u anry ranotnKhon a fhe <br /> pe�torm�nr,r,nf rnn5tn�di0n_ That I am authonzeA by(he orvner c`this Pmperty fo peAonn Ne <br /> work hu�Wud�app!it.�Ron�s madW anC I cornpty�vnh flra Stnfe Cnnna.nrrs Lnw 18 27 ft!'.W and <br /> 'l9C i00 W/1 C. <br /> �?'.�-------- �7AGC� O� _ <br /> C_s^'!1���--^ _ _• Date <br /> I . ._.._ —_�'— <br />