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� � <br /> � <br /> ELECTRICAL PERMIT APF�LICATION <br /> CITY OF EVERETT PERMIT SER'VICES <br /> 3200 CEDAR STREET, EVERETT, WA 98i01 r� _Z� �D� <br /> A25-257•8810 - FAX 425-257-8857 -www.ever�ttwa.org <br /> �pgll-// Z <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TCr 4 PM <br /> 3 �� 3 �� cqs� �o G:7 � �l 5 - 313 <br /> Pi20JECf AbDIZESS <br /> (y5� ) <br /> �oe� ,� a �Un� ��� ;vo3 � cas ,n � P� F��.-�-R� w� q$z� 3 yb-3y� <br /> Ownef M:�il qdtlress Clty Siate2�p Phono <br /> �o�.,�oJ `SVP�'�IH�2 l� �� i�vs 3�3F � q <br /> 30o a 1�.� co,s ino �c.�e (.,�A �'a �3 v�/✓� <br /> Tenant Midl Addtcas Ciry F�ulr.'zip Phor.e <br /> . �a o�� <br /> I�c>.c1�-r��.1cg.- Nlil�-V �711 w7c.tio'i1- �u-c �Ie� S.L�T�' wl� 9g� OL �h8•4a�� <br /> Electrical Contra�ta M;�il Address Cily StnI0f21C Pnone <br /> `1 <br /> v�Y��npn^i= 5� z t��r I/G,/�9 � ' ��� -''1 <br /> Slate Ucense Number Conlracl Pnce of Work CydS> <br /> C.o�'r�iti.xr� co.� ,Nlo.rk ��vq '7�c6-5"70l <br /> Pioposetl Use o1 Duildirg Contact Person (Plan Rev ) <br /> DeScription of Work lu Oe Done, I � %1 F V p1'�,�.E — �/1 S�11� � I;_�0.�' '�✓'�GR �a�V 0 I"I r <br /> �J <br /> __ z GI rCu � i'S ___— <br /> NOTE: WIRING IN NON-D14�LLLIMGS IS RE4UIRED TO FEE <br /> ESL- IN R�CEVVAYS, MC OR !1C CABLE <br /> CITY OF [V[RGTT LOCAL SALES TAX CODE IS�105 �t I <br /> J�� � <br /> . 1 here6y cer,�Iy fhat I have reetl end ox,�mmed fhrs appUcafirn antl know fhe same to bo frue avd � �" -� .I ` � <br /> conecl All provisro�s of/aws and ordinsnces yovemmg Ih�s fvpe o/work wtl�Ge eompleted <br /> whefher specrfed hnrem or not. i he gi3nfing of a pcmvf does n0t presumo t0 9�ve AuthO�ty It� , ����, ��� � <br /> viulnfe or ca�cel(he pmvrslons vl nny orhe�state orWcal Im�repWaPng construchun or tn � �� � <br /> peAom�ence o�ce❑svucGon. T��of I em aufho�ized by the ownNr ol Riis pioperty to perlor !re'�� {��; � <br /> �:ork lor wn,ch applrtation �s made and i comply with fhe Stafe Confrac�o�s Law 18.�7 RCl nd � t j� <br /> i9G 100 WAG. �,1�,'',' I <br /> ��_'�._ �-- • _ �j j 1i1.�1 <br /> `�:�,�_�=�—--�e,.``-� i� �i , 1 o�y � ���� !,,,,,. .� <br /> _ �,.�,���,� ---� �� �,,,�,,,,� <br />