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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 90201 <br />425-257-A810 - FAX 425-257-8857 - vrvvw everettwa org <br />i� z.a�x.��_u•1:a�.�� <br />Ownar <br />TPf1011� <br />[lacln�.al Cnnlr,uirn <br />S�ate Lir,nnse NumLiv <br />Propasod Use ol Buildlnc� <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />Mml AAdress <br />Mall Addi ess <br />A.1 ul AAdrr•.� <br />City <br />Clly <br />slatel;7p <br />StateRip <br />Cde ;tnIPZP <br />i:nnlia:! ?ricr� of Work <br />�_�s��6 <br />: 06 o��/a6 <br />Conlecl Person (Pler. Revlow) <br />f'hone <br />Phone <br />Phpnr; <br />� ' � ! <br />Dnscnpllon nf W ork M Bo Done: _L.. _� � � ( , �S �, �� / / /.�� .: � , _ _ <br />NOTf WIRING IN NON DWELLINGS IS REQUIRFD TO <br />EiE IP! RACFWAYS MC OR AC CABL[. <br />CITY OF EVERFTT LOCAL SALES TAX CODE IS 8105 <br />I hereby certrly thaf 1 have r�ud end exeminrd Ihrs epphrtihon nnd Fntiw fhe sente to be bue end <br />correr,f AN pinvi5lUnti p/ IAR'S BII(I OI(IIIIAl1GPS (J01�PII11ny flu5 (y/)P O(WOIk WIII bC completed <br />whefher speciM1ad h��rrin or nof The �/rantin� ol e pennif Aocs nnf nosumo fo yive euthonf�� fe <br />VIOIBiP 01 f,qllf.(�I �hf! /)lOVIS'Ol15 OI plly OiI1Bl S�fli@ CI IOfi)I iAW f0(fll�afmr� cunslnicfion or fhe <br />pertointance o/ ronstru�tion Thef I errr airthorirPd by fh�� uwner clllus properly (o pedumt fhe <br />work lor whieh nppbrnGon is rntvA�� and 1 i�arnply with fne� Sfefe Cenn�efors l.r�w 1977 RCW end <br />796 100 WAC. <br />. �� , <br />—_ Signalur�_ _ . _ .. —__ _ ._ _... - Li��ir_.-- --_--_ <br />FEE <br />����'L)� - IC'�" <br />