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��� . r� . p�0� i : pp;,l1 TECHNA S�STEI,�c ; �;i, !1_ . , � , p . <br /> , <br /> � ' <br /> � . <br /> ELECTRICAL PERMIT APPLICATION <br /> C17Y OF EVERETT PERMIT SERVICES <br /> I 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257•8810 - FAX 425-257-8857—www,everettwa.org <br /> APPLICATIONS ARE ACCEPTEP FROM 8 Ah4 TO 4 Pld <br /> ,-�,-e�e 'ti- �-�--rek.,�y C�N-�t�c. 1 � p � , <br /> :-.- � . � �!� 1�.� <br /> �7�� 't�v�oa�c.�,,�a�� �;�,r�l, <br /> P���C7 ADDRESS � <br /> !J <br /> Owne� ' IdallAdtlr¢ea Cl,y �� Stale2lp Pbene <br /> Tenant M¢ilAddrese Ciry . Sale2ip • Pnone <br /> �r�c ��- sys�r�►�s �ti� . � aU�s�T,���e �„� � ���� �� <br /> Electncal Contractor Mail AdCrees Ci,y ���S.L I�(��at�2p� �y p�,�one <br /> l0 <br /> TEC �-�+S L���/v .i 5"O O <br /> State Licanse Num6or ntract Prlce of WOrk <br /> _�y�,d,,Lr,,,���Q _Y�iNi� �Gi�-���0 <br /> PrOposed Use of 8ullding . , ' COntact Person (Plan Feview) <br /> T+ � I <br /> Des:rptlon of Work to 6e Dono: _/—L� �I,QY w� ,.LN $P,6-�� _ <br /> NOTE: WIRING IN NON•�WELLING5IS REQUIRED?0 FEB <br /> 9E IN RACEWAYS, h1C OR AC CABLE. � l� <br /> � , , <br /> CITY OF EVERETT LOCAL SALES TAX CODE 19 3105 . <br /> I hereby r,eMNy thpt I have read and examlrod fhls cppficrt%en and know the same!o be true and / <br /> correct. All provlslons C(laws and crdirances goveming,hls fyp9 0/work wlll be comple,6d <br /> whether spe:'lled hereln or not. The prenfrnp c(a porm7f does not resume to glvo euihoN:y to ;n � <br /> vio;ete or cancel(he p�vlsi�ns olcny othCf stefe or local law regUPSGng ccns;rucGcn c;the ��C <br /> per`oRnence cf ccnsWc;lpn. i het 1 Em fiu:horJzed by the cv.-ner cf thlsprcpoCy ta perlorm the il l � <br /> �rwk'cr v�hrch appllcaeon Is made Gnd!wmpry w;th tht-Sta;e Cen7zc�ors Lew iL'.27 RCV✓erd rl(a' U <br /> zse.zoo �vn.c. <br /> � p. � IIJ\/ I <br /> '�l C� ' %�"aGG� � <br /> SlQnature Dste I <br /> ��Ip�s.P ��e.P� �� ���. Qc«v( � 3�� 6s'y—�S'Uy , <br /> '�`S k �—p�' 5.�.r�.'�O r <br /> , ��.s� �.�x � �a s -as�- �-f G ����� ;,�< < <br />