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EL�CTRICAL PERMIT APPLICATION <br />CIl'Y OF EVERETT PERMIT SERVICES 6— 3 0—� v <br />::200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org �/ DD 6�/� 3 <br />APPLICATIONS ��RE ACCEPTED FROM 8 AM TO 4 PM <br />�o.ti ��%5"'" C�' � C EVPre i W�. �1 � c�: � <br />PROJECT ADDRESS <br />Ownor <br />MallAddross <br />)i� <br />c�e.:i �4�,�1 <br />Cl�y <br />� /�c'i�ie ������t[� _/_/)t. ��s�,��i G,cJe 5� llrnefi � �atys��ill: G��a <br />Tonanl A1ai� nddress C�ly Stalo2ip <br />Fledrical ConUactor nt�ii Address <br />c r� �c � r �.; �l ��/ N_5 `- "�> i�� z��, � <br />Slale Uconso Numbcr <br />Proposod Uso of �uilding <br />Descrip�ion af V�'ork to Oo Dono: <br />NOl [: W IRING IN NON-DWELLINGS IS R[QUIR[D TG <br />13f= IN RACFWAYS, MC OR AC CnDLG. <br />CITY n� EVERETT LOCAL SALES TAX CODE IS �105 <br />City <br />State/Zlp <br />liii' 7U <br />a C✓�. <br />�'-LSd-l�i )r� <br />Phono � <br />9PZ 7u 3G o�65�j �,i <br />Phora <br />Phune <br />ConUacl Pr'ce of Work <br />�i <br />�;.' q ��� /�� s��r'Z <br />Conlact Person (Plan Roview) <br />1 heinho- r�ntJy (haf f hm�e rend nnd e�anrninoJ this applicnfion nnd kiro�v fhr snme fo bo fruo end <br />com�iC �II provisions ollaws end ordinencns guvcrmng fhis typo ol wurk will b^ coruplelad <br />whefh��r specilicd hnrein or noL Thu ���ntint� o! a pernut Aoes nat uosumo t� giva eufhonty to <br />violafr or c��ncel fho �rovisions ol mry� othor stnfe er luc�l Inw re�ulnfing construclion or fho <br />perlorrnanco o/ cnns�iu�;fion. Th�rt I am eufho�ire d 6y tho o�rnw o! fhis proporty tu porlornt fho <br />�vo�k /o� which applicnfinn is made nnd I comply �rifh tl�e Sfafe Cenhnc(ora Lmv 18.27 RCW anA <br />19G.200 WAC. <br />r--� , <br />� ��«�/� ����c� . <br />---- S�nnetur� � Date -- <br />PEE <br />, <br />�n���, " ��''' <br />