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02/14/2013 21 5i k132G P. 002/002 <br /> � ----'-- .. . . . . ` <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF�EVERETT PERMIT SERVICES � <br /> 3200.CEDARSTREET, EVERETT, WA 98201 a _ �(�_�3 <br /> 425-257-8810 - FAX 425-257-8857—wwrv.overettwa.org <br /> APPLICATIONS.ARE ACCEPTED FROM e AM TO 4 PM �� 30a- �I�I <br /> Z Z 3 � �roti,� ,�� " ' <br /> PROJECTApDRESS ' <br /> - . , <br /> �Sur�K�e C-��f.-- .223�"Bvoe��.af �r.s+..�" � 98�/ yZ.i ZSZ—S/ <br /> OWnef Mail Address � City State2ip Phone <br /> _. I <br /> 7onant Mail Adaress CItY SfatrJZlp pnone I <br /> ��/�iYnAlr ✓A�1 !� SCizh kL ��3l0/ ��F'��G �� �g10� h��.s� 1 J � <br /> [le ricalCOntraclot MailAOtlress���� �� � Gty SWtelZip P�one <br /> ��L/9N5S /HtL/� ... --._... ....., . _ . _. .... .. . . /OL�o�.r <br /> Stato License Numbor - ' •�: - -. . . . •. , �ntract PriCe of Work � <br /> Gf�h'T ihCrG•;,� / ... . .. . . "' .. ' ' ' " ' I <br /> Pmposod llse of 8wldin8 -- Conlact Person (Plan Review) <br /> / /' I <br /> Description ot Work to Be Oone: rQ!?-5G: �G/� .g��' �lj� � ��� <br /> / � . <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO fEE <br /> EtE IN RACEWAYS, MC OR AC CABLE. I <br /> . . ��r ���� � <br /> qTY U�E'lERG7T LUCAL SALES TAX COUE IS 3105 . � <br /> I hereby cer;�ly that l havo rood and oxqm�ned ihi�appfication and know Ihe spme lo be true end L �>Q�- { � � <br /> co�ecL All�zvisions ol laws end ordlnances gnvoming fhis typn�(work wlq bo comp/efed <br /> whefhor specilied hEroin or not. 7ho gr.�ming ol a pnrmlt do9s nW pmsume fa yivo Authonty 10 <br /> vio/atewcancelfho nrovisionso/AnyothorsteYo�orlocallaWreBulatingcansbudionorthe <br /> peAo�mance ol constn�ction. Tbat I am authorrod by f6e ownor ol thia propoRylo pednmt the � . � . <br /> work Irv whicb appllcation is mado end I comply with the Sfafe Cont�ectors Law 18.27 P.CW and <br /> 296.2(iJ WAC. " <br /> �Til Gti'���� _---_.� '�r_�_ . <br /> SlpnaWte Q�ite <br /> ----__'_' ......._--`— ___..__..._. I <br />