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ELEC1'RICAL PERMIT RPPLiCA_ ION <br />CITY OF EUERETT PERIViIT SERVICES�t `�J(('�(� <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-6810 - FNX 425-257-8857 — www.everetiwa.org ;��(!�� 1 G <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PN <br />� 0 � ✓cr ree+-, !%Ni �' � `� <br />PROJECT ADDRE S <br />JivMind s �iz� <br />Owner <br />Tenant <br />�iinks ff�n�e ,Secur%r <br />Electricai Conlraclor ' <br />�oa ,5Y5.�S � <br />Stale License Number <br />Proposed Use of E3uilding <br />ii-a-�-a8 <br />�o81i--,O( <br />� 760/ �ve� ie�n ��u.� dN�-f8`� ,E'uerefl l,�%' 9�m3 <br />MailAddress ���Y 51o1e1Zip //y�! J7�?�y�j <br />r <br />ldail �ddress <br />Idai! Addmss <br />City <br />�pY,SE 5� /oo <br />c�ry <br />Description o( Work lo Be Done: �%l �U s�C <br />NOT[: WIRING IN NON-DWELLINGS IS REQUIRED TC <br />BE IN RACEWAYS, MC OR AC CABLE. <br />Slale2ip Phonc <br />�( �/A ��Ju �� �'L <br />Slate/Zip Phone�3 �l <br />� o <br />f�IGI.OD <br />Contract Price of Work <br />D� �r��f- <br />Contact Person (Plan Review) <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby cerlil}� fhat I have read ann exarnined this applicalion and hnmv the sarne lo be Irue and <br />correcf. �II provisans ollaws and ordinarcr,s governmg Ilus (ype o! work �vill be complefed <br />�•.hefher specdied herein or noG The g�anfing el a pennd daes not resunte fo give authority fo <br />violafe or cancel fhe provisions ol any olher sf?fe er local Iaw reguPting construc(ion or Ihe <br />perfonnance ol constiuchon. Thaf I am avthonzed by U:e owner o/Ihis property fo pedorm the <br />�rnrk lor which application is made and I compty �vith the State Conlractors Law 1 d.D RCih� and <br />29G.200 WAC. <br />��.,�,9�ia . %c' �/�/D g <br />FEE <br />�D r UO <br />[-0�11-10� <br />