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,I��n. "(L 2i113 12:"[yPlvl <br />�;o. S19� F. ; <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR S7REET, EVERETT, WA 88201 6_a�`�3 <br />425-257-8810 - F4X425-257-8857—www.everethva.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />�13b i,�oadau.wv� Av� � �'g�3 <br />PROJECT ADDRESS <br />Ownur <br />Tenanl <br />Eloctncal Condactor <br />Cm��+caM�an�aa <br />Slale l�cunse Num6er <br />Proposed Uso of Buildiny <br />Desr.riplian o� Wark tn De Done� <br />hlall Address <br />nn,n nad��ss <br />I.tatl Apdress <br />Clly <br />cay <br />City <br />� i3�6 /G/ <br />L�'Z� � !Q �f'ZciFCJ <br />SI�Ie2ip <br />siaiaz�p <br />Stulc�Zip <br />a� �-' <br />Conpacl Pnte of Wo�k <br />Comact I'erson (Ptan Review) <br />Phanc <br />Phone <br />�hono <br />NOTL: WIRING IN NON-DWELLINGS IS RE(�UIRLD TO <br />D[ IN RACEWAYS, MC OR �C CAdL[. <br />C�IY OF EVERETT LOCAI. 3AL[S TqX CODE IS 7105 <br />1 Aorcby cortdy (hat I hsvo road ond examined Ihrs appGcafion and knnw fhe samc lo bo (iue and <br />co�ucl. ��l provis�a�s ollnws and ortlinancos ,r]oveming fhrs fypa ol work wlll bo completnd <br />whr.ihor spoclficd horom or no7. The granlin,q ol a pennd �oos not prosumo to yivo aufhority (o <br />wolotc or canr.el Iho rowsio�is olany olhc� sfafe oifncallaw mgti/otinq conStruCtion or fhr. <br />por/ormencd ol consPn�cnon. Tba( I am aumooeod ey tho ovmer o/ fhls proporly 1n podorm 7he <br />�•+orit lar �vh�ch appllcofion is rnntlP and I comply wdh !he St61e Canfrot(ors Lavi 19.27 RCW ond <br />29G.200 Ih�AC. <br />FEE <br />56°° <br />��7�10 — �� 1 <br />