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� <br />� <br />ELECTt�ICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 90201 <br />425-257-8810 - FAX425-257-8857-www.everettwa.org �al.��/3 <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />In330 �-�i� A� k(, <br />PROJECT ADORESS <br />Owncr <br />A1ad <br />L <br />Tenant <br />�dail Addrrss <br />�� n6h:n��or1_�IG�rr__ 2D3� <br />ElectncalConhac r Ltaiinderess <br />\r,lAsFiv+i?.�2c3 <br />Statc License Numbcr <br />Praposod Use ot Budtling <br />Ciry <br />ciry <br />Slatc2ip <br />StalrJLip <br />Sta�c2ip <br />�Z_IC�1, <br />�� <br />Conhact Pncc ol Work � <br />Contact Petson (Plan Raview) <br />Phona <br />I'nono <br />Phono <br />I�" 1 � t <br />Descnption of Waik lo Be Done�. __ !__\_�,�1(�7 6J� S1� -�'(�(�j(��i��U� i C <br />� � <br />-- --- [L �i u�G� ��cr�srai-i'fer ------ <br />NOTE: WIRING IN NON•DWELLINGS IS REOUIRED TO FEE <br />�6 IN RACEWAYS, MC OR AC CABLE. �_ <br />cjb o6 <br />CIN OF EVERETT LOCAL SALES TA% CODE IS ]106 <br />1 �nrehy r.ortily (haf 1 havo mad;�nd oaarninnd llus appLcnUon and know Ilie SamO fo 60 INo ond <br />mnrrr,f AN provca�ns ollaws and orthn:m::ns ynvnmrnq Ihis lypo o/ work �vJl Ao complofotl �( 7, I�— I, r�l <br />ivhulhci spec�l;ed Iro�orn or rol. Tho gn, nlinq ol a pertrid docs noI presume lo g�vo aufNonty (o � `i�d`-' <br />violalo arcanccllho pmvrsions ol any ofhnr ;I,�Ir, or lar.all�w «:gulalinq mnshuclion orlhn <br />poRormanco o7tons nrc�on Thaf I am aulYonzod Ay Iho o�vnnro! fbis propmty lo pnrlom� fho <br />work lor which apphc -+tion rs nmde and 1 comp/Y �+'��h fhe Slafe Contrarfors (.aw 18 77 HCW anh <br />79G ; 00 tNAC. <br />—�y1 ra12v� � <br />/ ' j a rc -- — -- Dalc <br />