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ELEGTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERViCES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www everettwa.ory <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />1�1G loS�y %r S�� <br />i'iiOJECT ADDRESS <br />d,,,� :,� Hp,�F� _ _. <br />Owner A7ail Address City Slate2ip Phone <br />Tenanl � MailAddress 'City Shle/Lp Phonn <br />/'� l3pn <br />C�n,.�tirrE ��r¢�� �9ao--�e-�T �dr4 9B7i3 4z�-Is-z-443� <br />Eler.trical Contrac'or Ma�l AddrCss C �y Stt'e2ip Phune <br />. � � � n_• <br />��/�1283G� <br />State License IJumber Contract Price ol �Vork <br />Proposed Use ol C�ud<Lng Con�acl Pe�son Q'lan Revirw� <br />Descnpt�nn of Work lo l3e Done� __ �i'10e1LE �pi7�F �l//lF �_ i 2 _ <br />- - -- -- 75�� <br />NOTL: WIRING IN NON DWELLINGS IS REOUIRED TO <br />5E IN f2ACEWAY:;, MC OR AC CABLE. <br />CITV OF EVERETT LOCAL SA�_ES TAX CODE IS 3105 <br />I hereby cerlily (h�f I heoe read end ex�minrd Ihis applic.i0on nnJ know the snme (�� 6c f�ui� +ind <br />correcL All provisions ol l�ws and ordinances govrmin,q fhis ly po r�l N-ork will be compinled <br />whelhor specJied hrrein or nof Tho r�ranling ol n pennd no^s n�f presuma to givo nufhonty fo <br />violafe or cacee/ Ihr. �mvisions n/ any olher slafe o� lor.el law re�u/eUng r,unsbur.bon or!ho <br />peAormance o/%nns'n�chon Thaf 1 arn aufhonzed Ly fhn ��tiner o! fhis property fo perfonn fhe <br />work lo� whir.h npplicahon is mf�de and I cornply wiffr fhe SfafH Confrncfors I.aw 1 �,^7 RCW anA <br />196 200 WAC. <br />.' "_'.y�'l_ -- -- -- -- /�¢----- <br />Siqnature a�e <br />�rr - --r�,� -- — � <br />EI���- ��R _J <br />