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RUG-9-2�1^c 06:SSP FP.OM:PROFESSIO:JAL ELECTRI 360 435 1182 <br />T0:4252570857 P.1�1 <br />-���F`�Y � :�(��P�'( <br />ELECTRICAL PERMIT APPLICATION <br />CITY 4F EVERETT PERMIT SERVICES �`�o -iz <br />3200 CEDAR STREET, EVERETT, WA 98201 ���( <br />425-257-8810 - FAX 425-257-8857 - wwv+•everellwa.org L/ZO� `I <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />/ 6 /� 33 ^� s'� <br />PROJECT ADDRESS <br />W!, ,�"J c Y <br />� y � <br />OwnBf <br />,�� / rM 4-1" �/� <br />(„v. .f �upc.�.�j /• <br />�dall A dress <br />Clly <br />3 <br />y�� � �3 i-.J�`f / <br />Stale/Zip <br />Phono <br />Tenant Mail Addross City Slale2lp Phono <br />yy �—� <br />��,jS /UNd <br />/�/ec�c �-� fo✓� �7'S ./�i:. �6 �vif �ld'd�3 s.?o d�3o <br />ElreiriCal COn:r3etor Mall Addrecc Clty Slole/ZIV Phone <br />�.����.=s'v7�.� <br />Slale Licenso Numbcr <br />C. o i-, G�c� <br />Propoaed Uso of Dullding <br />�-� O V+ _ <br />Contracl Price of Work <br />Contac[ Person (Plan Review) <br />Description of Work to Oe Dono: �,l'��� ���• /`� �P�� O''� �� ���c J 2� �� <br />NOTE: WIRING IN NON-DWFLLINGS IS REQUIRED TO FEE <br />BE IN RACE�NAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 heroby certi(y fhat I have read ond exomined Ihis apF�ication and know Iho same 10 be 6ne nnd <br />corrocf. �ll p�ovision; of la�vs and ordlnances �overn(n� this type of wo�k will bv compinf�d <br />�vhelhor spedlled herein or noL The granfing ol a perm�l does no; urosumo fo pivo authoriry (o <br />Nolafe or cnncol the rovisions olany othor slete erlocal lew roe�ulufing consVuclion or fha <br />perlonnenco o(cans�ucf/on. Thet 1 am authorized by the ownor o/Ihls proporty lo porfomi fho <br />�vork /or which npplicnflon is rnpde and I comply wlfh fhe State ConVectors Lew iQ.2! RCW nnd <br />29G.200 WAC. <br />l��Z��"`-�`� <br />