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ELECTRICAL PERMIT A�PLICATION <br /> CITY OF EVERETT PERMIT SERVICES �f� .z� <br /> 3200 CEDAR STREET, EVERETT, WA 98207 <br /> 425-257-8810 - FAX 425 257-8857-www.everettwa.org /D L� ���� <br /> L <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> L G�O �z�1/ C6S/.'7✓" �,[,t,L T� r-c,:� <br /> PROJECT ADDRESS <br /> L 13/4 � c�u l�y �� � c� nqo� �'o� kar..,oH �J„e J rv�He C,�'� <br /> Owner , ai�ndmess C�ry S�ateiZio qy4 9Sgn0189,; � <br /> / (yaS) <br /> �/tii20� L.�a�� � �icS � (o/u W��* (uSi..o ���ctf (.�� 9�7� � `�356- DY <br /> Tenen� Mail Atltlress CAy Slale2ip Phona <br /> .�../ q�/ N7s <br /> i/ ��IZfJ'� .-� yU3 w�S � Lr.li�.r0 f-'✓�. cl / (/t//Y / 7J � �C/ .1 �$ a05S� <br /> EledncalContrac�or MaAAAtlress Cdy 1 Slale2ip Phone <br /> 3� 3U 13Y,�-U � y� Docl , �ro <br /> Slale License Number Contrad Price ol Work <br /> � <br /> �� `'i ( ( � <br /> Proposetl Use ol Bwltlmg Contac!Pe�son (Plan Reviewl <br /> Descnption ol Work to Be Done .i�•�11 �`� ' ` � � ��'/��C� �l n� C P q ✓t p V �" " <br /> (_�i.i / 't' Y �' <br /> NOTE WIRING IN NON-DWELLINGS IS REOUIRCD TO FEE <br /> BE iN RACEWAYS, MC OR AC Ci�LE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS]106 <br /> 1 haoby caLly fhaf 1 bav�read nnAo�ammod flus applica6on and hnow fho same to be frue and <br /> conocf All proas�ons ol l.nvs and onlrnanans yovan�ng Ih.�s fp,�e ol work wdl be cornpleled <br /> Khr,thor spocAiod hoiuin o�not Thn yi,n6ng o!o pvm�d dnes r�f iosurrre fo grve aulhordy fo <br /> v�olafa o�cancol the/vovisiorrs o!any ofhcr sfato or local law ieguPbng conshuclrorr or flre <br /> perlonnari ro ol.ronsfn�chon That 1 am auflrunzod Gy fhe owner ol this proporty fo porlo�m fhe �l <br /> wo�k lor which npp6cafron�s mnno and I cv�mply wdh fhn Sfafe Corrfracfois Lnw 18 27 RCW end <br /> �9�zao WA� ���. <br /> ,. � - �� ll <br /> '� ��- � � � � = �� 7 - <br /> :igllaturr Uato �. <br />