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APR-20-2011 19:34 From: To:257B857 Pa9e:1�1 <br />'v. <br />ELECTRICAL PERMIT APPLICATION <br />:, CITY OF EVERETT PERMIT SERV�CES <br />,. � 3200 CEDAR STREE7, EVERE'fT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everellwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM 70 4 PM <br />��{�� �`r�0.�� <br />PROJECT ADDR6SS <br />. <br />Owner <br />Elcclrical Contracto� <br />A1ait Atldress <br />#oU��.,� <br />Mail Adaress <br />��'� � <br />Mall Address <br />so�uzrP ��i��D7 <br />State Lir,anse Number <br />Propused Usr. of Huiltlinp <br />Descrip�ion of Work to Be Done: <br />�ily <br />Clly <br />Ciry <br />Slale2ip � / � <br />as� <br />SlaleRip <br />i ?D� I �a� <br />StatelZip <br />� 5, � �3 <br />Conlract Pdce o( Work <br />�en 5��� <br />Conlact Person (Plan Review) <br />PhOnO <br />��� <br />Phpn¢ <br />P�OnO <br />NOTE: W IRING IN NON-DWEILINGS IS REQUIRED l"O <br />BE IN RACEWAYS, MC OR AC CABIE. <br />GITY OF EVERETT LOCAI SALES TAX COOE IS J105 <br />I hereby ceR1ly lhaf I hnve read and oxamined this appllcafioo end know fhe snme fo bo We and <br />correct Nf provlslons of Ipws ond orQinances govammg fhis type of work wifl bo complefed <br />wheuter spee�lled herein or not. 7'ha granting oI a permrt aoos not rosumo fo give aufhonty to <br />violofe or cance! Iho provisions o1 any other slafe orloca� Inw roguPnflnp conswctlon or the <br />peAOr+nance o/consfrucfion. Thaf ! am authorizod by fho ownorol fhls p�operty to peAorm !he <br />wo^k !or which applicafion fs mado and I comply wi(h the Sfefe Contrac(ors Law 18.27 RC W and <br />��� c� '���9� ) �a5y� <br />�..� ��..�:� c�rnour�- -�-�a <br />FEE ��� • <br />Ai � . <br />�J»�� - v`�� <br />