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ELECTRICAL PERh'lIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 C[DAR STREET, �VERET T, WA �A201 <br />425-257-8A1n - FNi 415-257-8857 - www.evcrettwa.org <br />APPUGAT10N5 ARE AGCEPTED FROM E AM TO 4 PM <br />—�- _ _ _ - ---- <br />,�-,:.�-t-= / p�^�,� �--- --- - — - -- <br />_ /�� 9,;... �' � � r_St,/ .la��' <br />PROJ[CT MpRESS <br />�� <br />�� r � r,�r.-v- ��.� �- <br />OWnef � M�tln+ss _--_� -.�.-� Cit;• --�—_'— Slute�Zip <br />—_ �._ _ . . . .. .._. .,_.� <br />Tenanl Mall lJklrese <br />r,iry <br />7-/O -0 7 <br />� 070�-�3� <br />Phcne <br />State2ip Phone <br />�or��r./'n _ ����i7 .L�'<—�nP� <br />Clectncal Contrnctor Mml Acidress Cty Sra�rZp <br />SL•�lp IJr,�nSa Numbnr � � ronher,l Pncr. of Work <br />�'i��pw;ntl Ilr;e ul liiiildinq <br />f>esr:ription ol Wnrk In Pe Dnnu: ._ _ �� � 4_. <br />Phone <br />. .. - . - i:unlaCt fbraan (Plan Revlew) <br />I%G7.✓ 1 ���+7 t`— ------- - — -- <br />NC)Tt . W IRING IN NON L WLLLINGS IS RL=QUIRCG 10 <br />RF IN Rl1Cf•WA�S, MC Ofl AC Cl1BLC. <br />C:ITV Of 6Vt-RFTT LOCAI. SALES tAX CODC IS :1105 <br />I hrveb�. cnrtr(p fhaf ! hnvn ruail ond exom/netl fhis npPhrnhcn UrN Anow thc smm� !o he VuP nnd <br />,�� �na�.f AN ph!i i:l, �ns ��l INWfi nn0 "nLnMCeS povr.rmny thrs IYPe� n/ w�vk nall he� cornpleled <br />n�he(har Spnr,di��J hUiein p� not ThP. yj��OfIl1Q ol (1 OO��INI Ai4`9 np( i�rsurne M pive au(honty fo <br />ar:rl,�fe ni cnnce! fhe pnrvl5ion5 0l �rry n1h�� stnte or Inrni h�w rrgufePr�p i�nnsfruc6on o! the <br />�„-•rin.m�nre ol consfnrotion Ill�t 1 am authon:ad hr Ihn r,wnwr ut f/us Pr�Uody tV PPI(Ortn Ihn <br />u� vk l0� �vh�rh nppLr.afion is inado anA I comply wttfi thr S:ahi C�mlr,�clois l.aw 1F.27 RCW enU <br />; Jti.100 Ih'A('. <br />FEE <br />!� .+"J `��` _ct "�` � /� O <br />_'_'.�i4n:tt�ne �`___ )nl� � _ <br />t-U]G1-G3�j <br />- ...-- - ; - ---__—_ <br />-- - <br />iN 3`.�'..�I I�i13 1�1L�1� II.�-.t'�{li�l.itl HLSHF,95f19F N'y:HU LRL1C/QT/LO <br />