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1?/19;2�1U 11:48 4253776577 EOSCH ELECTP.IC IIJC FAGE 01/01 <br />� <br />�LECTRICAL PERMIT APPLICQ►.TION <br />CITY OF E�/ERETT PERMlT SERVICES - <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FA� 425-257-8857 — www,everettwa.org <br />APPLICATIONS ARE ACCEPTEp PROM 8 AM To a�M - DEBIT & CR[DIT CAROS ARE NOT ACCEPTEA <br />-��o c��de�. <br />PROJECS'ApDRESS <br />Owner <br />Tenant <br />Elncfical Contrector <br />�SP.� ' <br />Mail qddreys <br />Mall Addr855 <br />Mqil AUtlress <br />f�Dsc�i- Z�' �' 3 Q i <br />State L�censo Numbor <br />r <br />Proposed Usc of 6uifding <br />Oescriptlon of Work to Be Done: <br />NOTE: WIRING IN NUP1-DWELLINGS IS R�QUIREO TO <br />B[ IN R/aCEWAYS, MC OR AC CABI_E. <br />CITY OF EVERETT LOCAL SAI�S TAX CODE IS 3105 <br />Ciy <br />City <br />SIahJZip <br />Stele2lp <br />Stafe/Zip <br />Contract Prfee of Work <br />ConWct Persun (Plan Revicw) <br />I herpby cuRify thot / have �ead and exomined fhis applicaNen anJ krtav fhe sume to be trve and <br />cor�ecL Al/ p�ovlsions of lavrs and orc1/n3nces govammg tlrls lt7�u ol work �•�il! be complefnd <br />k-hether spCCifiod her�in or nol. The y�antinr� ol a pomttt does no[ msume• to grve auLronty to <br />violate or cancul the tprovls�ons of any otl�nr sfate or foca/ law �egu�tingp construcf(on or the <br />�a�k orevprch app11 ce�otn is rnode� und I comply�i�tl the 3tn e Confnic(o s L w �� 2 f2CW end <br />2sc.2oo w.�c. <br />-IF- <br />FEE <br />�ol!-I°�° <br />l 2 <br />Phone <br />Fhony <br />i � �0 <br />Phpnn <br />