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� <br />I ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />37_00 CFD�R STRE6T. EV[RETT. WA ��32(�, y_a4-�� <br />d:_�i-257-bP1G - FAX 425-257-8857 �+nvw ev�re hva ory C Oc� pG—� 3� <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />,}. 1 � C�.�c �� � , S � <br />PROJECTADDRESS <br />-�,��_4 ^ �`�� <br />Owne� G1ai1 AAdiess <br />Trtndnt <br />Eh�dncal <br />Mail AdAress <br />\' . <br />Wail Addiess <br />\) �`� 1�t�i c= .1. 9 5� C� <br />Slale Liccnse Numbr.r <br />Fropu� U���inlding <br />Descriplion ol Work lo Dc Done. <br />L <br />I NOTE WIRING IN NON-DWELLINGS IS Rl:OUIRED TO <br />I BG IN RAC[WAVS. MC OR AC CA�LE <br />City <br />Gy <br />C�ly <br />Slate'Zip Phane <br />SIBIq;?ip f'linnP <br />, �, �{ 2 5 <br />�.Q w� 5o�s -c�; <br />SIaINdp Pno�,�• <br />Conirect Prico of Work <br />�` <br />i�\O�.' _i��_��'� <br />Contacl Person IPlan Revicwl <br />I CITY Of EVER[TT LOCAI SALES TAX COUE IS 3105 <br />� I hc�rbF �:viGl�� th;if I hu�r rr,iJ;�nd r�anun�=J tlus ap��L�rahun anJ knu�t� fhr sdrn�� lo be h��e nnA <br />.�nnecl� All prov�sionti � 4 Lm ti nnrl nrd�n;�na�s 4ovrmrng Ihis fype o/ work wdl be rornpleted <br />�, whrfher spocJied he�eui r� n��f ]he y�antmp ol e prnnd doos not �resume fo grve eufhon.'y fo <br />i violafe or cancel lhP pr��isi�nis o! eny o(ha stefe or local la�r repuleting consl�uc6on or fhe <br />I paAom�ance o! runsf�udion Ihaf I am aufl:oriTed hy fhe ow�u� ol fhis p�operty fo perlo�m the <br />. wark lor which �pphrnfion is madF ond I comply utivfh the Sla(e Con6ncfors Lrfw 18 27 RCW end <br />. 296 200 WAC. <br />� -> - � 1 <br />gnah rr: - � --- ---- —_. ___ Date � � <br />FEE � <br />' <br />� <br />