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MAY-23-2012 22:44 From: To:2578857 Paee: i�l <br /> I <br /> , ELECTRICAL PERIV�IT APPLICATION <br /> •CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, [VERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257•8857 —�vww.everelhvaorg <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> :� <br /> 3 k �q � r�ac�,�a.�-a- <br /> PROJECT ADDRESS <br /> �wncr ' Mail AtlOress Cily SWIo2ip Phone <br /> �—�-1of—a-►2� �tt� SCl�✓�> �'�Z� '� <br /> Tenant 1 � MailAddress C,ily Slafe/Z��p Phme <br /> <�4�r�ra� �C,t�i� aa� i �' ��� �PG�P�- W� �1K7o1 4��36�5 <br /> EleCtriCal Coniractor Mail Addross Gry Slate2ip �'hone <br /> �So�z�P ��'��D� �, 35 � � <br /> Slate License Number Contract Price of Work <br /> � � ,� � �, .5��' <br /> Proposcd Uce o�8uildmg � Contact Poreon (Plan Roview) <br /> Description of Wo�k to do done: ,�,L 1� �, Y� I ��'1C. <�� S��� <br /> con�"b / C��ev�c��s� <br /> Y, � <br /> NOTE: WIRING IN NON-DWELLINGS IS R[�UIRED TO FEE <br /> eE IN RACEWAYS, MC OR AC CABLE. � (� <br /> CITY OF EVEREtt LOCAL SALES TAX COD[�S 3105 r1 G /� <br /> I h�reby cerirry that 1 have reed and examrnod this apAlication and know the samo fo be true and �i l � J� I�v <br /> conor,t. All provislons o(laws snd ortlinances gnveming fhis fype of work will be complefed <br /> wF efho�specil�ed hereln or not. The 9rOn(inq a/o permrf doos notp resums to giva authonty to I <br /> v�o�ato er cancel fho provisions o(eny other s(nte orlocallaw rogu/efing consfrvchon or tha i <br /> pedom��nca ci1 construcGon. Thaf l am eu0�ori�ed by the owner o/fhis property fo peAorm fhe I <br /> work lor whicb app�icafion is made end i comply wifh the Sfsfe Contracfors Law 18.27 RCV✓and <br /> 29G.2 WAO. �� — I <br /> � � , � <br /> ' ignalure Dal - <br /> ��.� Cc,t�4 4�" `'7? ) '�,5�� . , <br /> __ _.���`�'r�`�".U�°"�---�a"��- — _ <br />