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ELEGTRICAL PERMIT APPLICATION <br />CITY OF EVERETI' P�RMIT SERVICES ��7 ��� <br />3200 CEDAR STREET, EVERETT, WA 98201 d` �1 <br />425-257-8810 - FAX 425-25'-8857 - www.everetlwa.org � g(J�-d � d� <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />��?�� %�� �1, S�, <br />PROJECT AUDRESS <br />�j/,� <br />Y'�GI J G� _ � �7%�i �� <br />/ <br />Owncr Mail Atldress Cily <br />T�Cll:till <br />�'G�,r� s L/�� <br />[InciricFll CaNraclor <br />Mail AAdiess <br />City <br />/ �S'"� �� /� Cv <br />Mail Address <br />��1.��,� �-.�D�9,�� <br />State L�censr. Numbcr <br />Proputicd Uso ul f3utldin�� <br />Doscnplion o� Wurk lo [3c Uonu� <br />rC <br />NOTE WIRING IN NON�DVVELUNGS IS REQUIRED 1 O <br />BF W RACGWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />Cily <br />�o �� <br />Slatc�Zip <br />Stalo2ip <br />S�-r,��c.�no� C <br />SlatelZip <br />Phonc <br />Phono <br />� 'L <br />Phonc <br />--�� - <br />Conlract Price of Work <br />Conlact Person (Plan Review) <br />I hrrrhv � rrtJ} tlr�f I hdi r rrnd and oaamntod Ihis ripp6cnhrn ��nd Ano�s fhi� sonrc to hc 6uo and <br />r.v�rc( All pr����s�,,ns �,I Inws ��rrd uid�nancns gavenun�� fhi<fypc nl �tvr6 ��all b� compH�fcd <br />nlndh�v .qrn,-iM�d h�vr�n ,,r nnt Ihr yrnrrhn� ol a porrnd J.res n�it nesume fu gi��e nufhonly fo <br />uola(o rn rnnnrlVir �nrn�isrcns ol nny ofher st e or local la�v regu��6n� consfrucfion or fhe <br />pi�rtorma�irr a! cckrs rucGon lhet 1 arn ,x huli rd by fhe o�rnei a( fhrs pwporty fo pe�fonn fh�� <br />�t�n6 li,� �vhri�h ap�jHcafi�Hr is n.�dF arid4 r�rnp y �rrth fhe Stnte Conlractors Law f0.27 RCW and <br />7U�i?GO WAG'. � ' . <br />� <br />_ . _ � ��� � .' /�" �' . / <br />� �t�' � f �,�'� ----_,����� <br />Sinnatmr- } __�. __ y - Unle <br />r.s <br />FE E <br />/ ��j L:L� � <br />�L. �`i S <br />