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ELECTF�ICAL PERMIT APPLICATION <br />CITY flF EVERETT PERMIT S�RVICES <br />3200 CEDAR STREET, EVERErf, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.evereltwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AIN TO 4 PM <br />�%/i� ��� P� (A!� E"�/.2r-C.� <br />PROJECT ADDRESS <br />Owner <br />Tenant <br />i7 <br />Mail �ddross <br />Mail Address <br />:�� E(P�.1-r:l,T�nr P��}� � <br />ConUactor Mail Address <br />v n�. �1 cE -� ti� � n M c°., <br />Stale Llconso Number <br />Proposed Use of Buildfnp <br />Doscription of Work to Bo Dono: <br />NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO <br />BE IN RACEN�'AYS, MC OR AC CABLE. <br />CITY JF EVERETT LOCAL SALES TAX CODE �S 3105 <br />I horoby certi/y that I have read and exemined thls applicatlon and <br />corroct. A/l provislons o/ laws and ordinances goveming this rype <br />whofiier speclfied heroin or noL The grant/ng of a pemut does nof <br />vio/ofeorcanceltho proWslonso(anyotherstateorlocallawregu <br />perlormance o/ const lon. 7het 1 am euthonzod by Iho owner oi <br />work (or whlch appll n(i n Is madq and I comply wlth fho Sfato Cor <br />296.200 WAC. / <br />� <br />Clty <br />Clty <br />� <br />City <br />� ��.(25)�9i S-8S <br />rdal.'i(IG, " l�l/f'r�� <br />swcerzia 9 �2��°l'a <br />StatelLip <br />State2lp <br />��Q�� <br />Vad Price of Work <br />Contac[ Person (Plan Review) <br />�e to 6e frue end <br />> comp/ated <br />Ive authonty to <br />ction or the <br />to porlorm the <br />98.27 RCW and <br />-�0-7 <br />� <br />FEE <br />Phone <br />yt� <br />Phone <br />� o��� - ��,� <br />COO;f.00QJ �12I.L�FI'IiI "I'I:IV21\',\ OER!SCES7h SI':I 7.7.:t1 !OOZ/0[/80 <br />