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06/13/�012 WCD 17: 36 PAX 0003/OU3 <br /> .... __-_._ . __.._ __.....__...___. . . . ._. . ._ _ . . _ ... . . _. .______.._._._-__- <br /> r <br /> � � 001/OA1 <br /> Ot/13/2010 16�.06 FAX 425 257 '. �T EVEkETT PEflMIT SER4ICES � <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVER�TT PERMIT SERVICES <br /> 3200 C[DAR STREET, EVERETT,VJA 88201 <br /> 425-257-8810 - FAX 425-257-8857—www.everettwa.org <br /> APPLICATIOIJS ARE ACCEPTEp FROM 8 AM TO 4 pM <br /> �I�, `��� � 12(�� . , fl�J� <br /> PROJECTiWDRESS <br /> �0 � �c� ��� ^ �. 4� . <br /> � MallAddross Gly s�eieiZ+v �P+ry�e� G, <br /> L. <br /> Tananl bla�nddrese c+ty Statotip Pnone <br /> �,Qv��ir�n C��n�flv�l�iC, 111D�1191�`��'�I�C �v,(,11u,�,1�� Q���� <br /> EIeGNcal Contraclot Mail Addresa Cay � SWIe2�u� n� .,\ �����Tq �. <br /> /t III1 �J <br /> ��� �,.��. <br /> ��c� �i� � <br /> Stete License Num6er � CoMract PFlce of Work <br /> ���1.��-. 6 5'�1VL.�f°'ll�- � zNv1�1LU��/X.� <br /> ProW sa0 Use of Bullding Contact Person (Plan Review) <br /> Oesa;ptionof Work lo De dono: ���„ / .1 A ) IA IM- � (JL.Y �`� ��� � <br /> NOTE: WIRINp IN NON-DWELLINGS 13 R[QUIItEU TO FEE � <br /> B�IN (Z4CEWAY5,MC OR AC CADLE. Q/� <br /> uV <br /> CITY OF EV[RETT LOCAL SAL85 TAX GODE IS 3105 <br /> 1 hereby certlly Qiaf!havo reatl and exembied this applic.;flen and know the same fo be tme and � 1� �Zr <br /> correcf. Allprc��slonsoflawsandord/nancesgovomingtbisnPeolwortrxlll6ewmpletcV N <br /> n•heNer speGfied here'rn or n01- Tho g�anflnp oi a perm�f do65 notP resrrme fo glvo authority to <br /> �iolato orcencel ihe provlNons ofany other sfate orlocNlew regulatinQ consfrucNon orfhe <br /> wmsncg o!cunstrunion. 7hof 1 am eufhonzod by Ne owner of fhls�roperty to paAorm the <br /> (or�+idch n pllcat on 15 modlt and I romp(y�ti�lh tho SYate Contrectors Law 19.27 RCW and <br /> 6. OO IYAC <br /> . ._ � _ . � ... . � 2 . <br /> ��natura ate <br />