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Jla-30-2009 19:05 From: To:2578857 Paee:l�l <br />f <br />ELECTRIC�L PERMIT APPLICATION <br />.. EITY OF EVERETT PERMIT SERVICES <br />„ <br />;�� 3200 CEDAR S7REET, EVERETT. WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPIICATIONS ARE ACCEPTED FROM B AM TO 4 PM <br />� o 01 N� i3r�d� ��-? <br />PROJECT ADDRESS <br />Uwner <br />, <br />. <br />Mail Addr055 <br />� <br />Moil Addicss <br />� <br />Electrical COntlaClo� Mail AAdie�a <br />So�ztP �����7 <br />State Llcense Number <br />Propused �e�g ' <br />Desr.riplion of Woik to Be Donr.� <br />n <br />NOT[: WIRING IN NON-OWELLINGS IS REQUIRE� TO <br />BE IN RAC[WAYS, MC OR �C CABLE. <br />Cuy <br />Clty <br />Stalc2ip P�cne <br />Slate/Zip Phono <br />UP�P�� �1K?01 `�a �.��.� <br />Ciry Slale2ip PAono <br />� 3, 2�� <br />CoNracl Price ot Work <br />�n�� <br />Conlacl Person (Plan Review) <br />0 <br />CITY OF EV[R[TT LOGAL SALE3 7Alf CODL• 19 3109 <br />f he�eby cerfdy that 1 have rr,ed end o.ramined fhis eppli�afion end know Ihe same to Ae frue nnd <br />currecr. aa prwisions o� �aws anJ ordmances governing tbls type of worB wN Oe Comp�eted <br />whelhCr Spncfixd hurein or noL T he prenting ol a pernuf doeb n01 rrsume to pivc au7hodty Ie <br />violate o� canccl llio provisions c.' any ofhe� sfefe or local law repuPfmp conshucf/on o�the <br />is <br />'e Con6ac(ois Lew 1827 RCW end <br />�13� 09 <br />�- y—�,yiqnemre / OOte <br />Ql��e c.� ��?_S �ii ) -a5y� <br />FEE <br />���� �� , <br />� <br />