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Nov OS 10 10:51p AI Thom <br />� <br />360-568-8400 p.2 <br />ELEC'TRICAL PERMlT APPLICATION <br />CITY OF �VERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, �bA 98201 <br />425-257-8810 - FAX425-257-8857—www.evereriwa.org <br />ii -- 9—io <br />APPLICATIOhS ARC ACCEPTED FROM 8 AM TO 4 PM <br />r_,o i� ��4�� <br />ADDRESS <br />Contractar <br />`` a�-I <br />1�,�� 1� EL�� <<���� �, v�1G <br />Mail Addresc Ciry <br />�1� `�� � e �� <br />Mail dress City <br />��-'0:�� 13� ;'� I Sn�h <br />Mail Atldre55 City <br />.�1r,TQ�F� �--�i�/,Y>O� <br />State License Number <br />Y�a� r,� �l <br />Pr�pas-'—ed�l se af Building <br />Descriptian of Work to Be Done: <br />NOTG: WIRING IN NON-DWELLINGS IS R[QUIR[D TO <br />BE IN R4C[WAYS, MC 04 AC CABLE. <br />CITY OF I:VcRETT LOCAL SALES TAX CODE IS 3105 <br />! herebvi ceRilv �har I neve ead and examined this application and <br />�-i- V�la ,`1�L1� <br />Slale!"Lip Phone <br />Stale/Zip Phone <br />��4. ��1� l r���-`l l <br />Stalc/Zip Phane <br />� 1��� �c7 <br />Contract Price of Work <br />Contact Person (Plan Review) <br />the snme to 6e Irue and <br />k wdl be comp/eled <br />me to give authonty to <br />construcfion or 1he <br />irOperty (o perfarm the <br />irs Law 1827 RCW and <br />FEE <br />�l!°i �rv <br />Dalc i I i�-D <br />