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06/21/2J05 07:37 36065985'8 <br />{ <br />NORTHERN LIGHT ELECT <br />PAGE 03 <br />ELECTRICAL PERMIT APPLIC�TION <br />CITY OF EVERETT PERMIT SERVICES 6�a�`D S <br />3200 CEDAR STREET, EVERETT, WA 98201 � Q S0 6–� c�-� <br />425-257-8810 - FAX 425-257-8857 –www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDR CARD3 ARE NOT ACCEPTED <br />� 6.Z 7 Qr vtir�j/ U�vo� /`f <br />PROJECTADDRES9 _—T <br />Owner <br />Tenxnl <br />Electrlcal <br />Sta�c Liconcv Number <br />Addnu <br />M�II Atldiasa <br />�� <br />Mell Addres7 <br />Proposed Use uf Buildlnq � <br />Descdppon of Work fn 0e Donu; <br />NOTE: WIRING I�J NON-DWELLIN4S IS REQl11RED TO <br />8E IN RACEWAI'S, MC OR AC CABLE. <br />CITY OF EVERfiTT LOCAL SALES TAX CODE IS 3105 <br />I hereby wrtily that I have reed dnd <br />wr.at All p�pvrsions ollewa an0 � <br />whether spatille0 t�e�ein or nut Thi <br />vlclefe ar cancel the provrsicns a/ ei <br />wc �/0 ewh ch/aPP��No �+s mede � <br />2ee.2oo wac. <br />City <br />ciry <br />Ciry <br />Stata.2iD <br />StatelZip <br />SGtHZJp <br />CoMrect P�ice of Work <br />Contact Person (Plan Review) <br />nine0 Mls application antl know tAe seme to Oe true end <br />inces Bovfmrnp Nis type al work wlll be comple[ed <br />ntMg of e permn does notp resume to prve authorrty to <br />ier stav orloeal law regu�atInfl conshucflon orthe <br />�uthcrled by the c�vrer ol fhis property to per(orm Nto <br />comply wdh the State Contractors Lew 18.27 RGLY end <br />. �/z�/o ;3--� <br />FEE <br />L- �C�l� "/Z <br />Pnone <br />Pnone <br />Phme <br />