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ELECTt21CAL PERMIT APPLICATION <br />CITY OF EVERETT PERMiT SERVICES <br />3200 CEDAR STREE i, EVERETT, WA 96201 <br />425-257-8810 • FAX 425-257-8857 — an�v.everetriva.org <br />APPLICP,TIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />g�O �I I�1''OA (i W Q.+.1 �U PXt'I"+ V�J�} ��� I <br />PROJECT ADDRESS <br />Tess Morr�►�5 3bo �53 a4$� <br />�uciwMo�leS �I25512 2�l0� .� <br />, <br />Owner Mail AdCress Cily <br />Tenant <br />Electnwl Contractor <br />Cn1 Fii�l�i FI �1 UI C��i <br />State L�cense Number <br />Proposed Use of 8wldiny <br />Description o( Work to Be Done: <br />Ma�l AdCress <br />I'tl5 � <br />6tail Aaaress <br />Cily <br />Gty <br />sconne�ti nq �1- <br />0 � � �/2 �"o Y1 ura � <br />NOTE: WIRING IN NON•DWE�LINGS IS REQUIRED TO <br />BE !N RACEWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 1105 <br />� <br />State/Zlp <br />� <br />Slate2�p <br />I � <br />Slate2�p <br />Phone <br />Phonc <br />Phone <br />Z50 ` <br />CaNract Pnce of Work <br />Lylz �25-i5�} 12�5 <br />Conlact Person (Plan Review) <br />1 hereby certJy fhat I have read and examinod Ihis applicafion and xnou- fho same fo be 6ue and <br />correcl. iill provi5�ons olla�vs and ordrnancos govemmg fhis type o/ �se�k �vJl bo compleled <br />��:hefher speciGed hcrorn or noL The grantmq of a permd rloes not prnsume (o give aufhoritylo <br />violafe or cancollho piovisions of any other state orlccal law regulalmg cons(ruttron orlhe <br />peAonnanco ol constiuclion. Tha( I ar,� aufhonzed by tho owner ollhis property fo perlorm the <br />�vo�k for whrch application is made and ! comply �vilh t.he S(a(e Confractas La�v 18.27 RCL4� and <br />:96.200 WAC. <br />u v�i <br />FEE <br />5a�° <br />�130 � -175 <br />