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O1/25,'�007 02 32 20G3883376 A3488 P. 005/OOE <br /> ( � <br /> '-� — <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY �F EVERETT PERMIT SERVICES <br /> 320� C6DAR STREET. CVERETT,WA 38201 <br /> 425-257-8810 - F/UC 42F>257-8857 -www.everettv/3.org <br /> APPLICATION3 ARE ACCEP iFD FROM 8 AM TO 4 PM <br /> ��^J_._.��.sinll�'�! �ve+rert,_w� 982uy _ ���.� .�— an�a � <br /> PROJECT ADDRESS <br /> �et S�u�d �v���rau PO B� 9G8�t� 3e11�vue, �vA 9��Cy 2��� ��4 c��c:l <br /> CTvnCf Mm( d ..S Ciry S�ate2ip Phone <br /> Tenant htan nddrrs;. Ciry SuluLp Phor�c <br /> �,r,ec� l C.GPP aba . � <br /> ur��� Electr�G (o4�I2 5. I��.S�"*3 lukw� l� v� 981C�S �� ���19�c�r;� � <br /> [hr.inml Cnnttthnf Mail Addmss CR7 SlatuiLp F'horn <br /> ._� u�3r,Nc x��EB� ��t�o <br /> Statc l imnse Numtntr Contratt F�ieo ol Work <br /> .��FGV II�� '{-25•3fjT �13v <br /> PmFvsed Use of Building Contact Penon (Plan Revrw) <br /> � Dcscnplion vI Work 10[3e Dane �utt .1 l_!rC�l.l � _ <br /> NOTE: WIRING IN NON-DW[LLINOS IS RLQUIRGD TO FEE <br /> pF IN RI�CFWAYS, MC OR AC C�RLC. <br /> CITY UF EVL'R[TT LOCAL SAlES TAX CODG IS 3106 <br /> �he�eby r.e�1iN th3t�hmv rotid a�d 9+aroine.d this ap;z0i�fqn end Wron�;he Samr f�6e!ru0 a���� <br /> mRPcf. All pmvismrrs oJ/Bn'S 3nAOrt7inu�k.vs y�vennnU dus fyp�t U7 n�oik will bo mmplCtPd <br /> xhr.Vrer 5/k?cfin�ht>nvn ur npf. Tlre przmhrn7 01 d per171rt durs rotp vsums to giM aufho�fy to <br /> rola;n ui ofnevl Urrn provrsron5 ��any other s;afe or lor.af law q,yulntiry pOnNNchon or tho <br /> porlormanw c�u,n>tru<tron Th,t(I am authontnl hy tDe punBr o/fhis prppB4y ro pcilomt(he <br /> work fe�wlrrch:;p�'�ud�cn rs made end I i�nrp,'y w�ith the St,lfe Canfradors Law 18 2'RC15'and <br /> 296 200�5 AC. <br /> I i <br /> - _t,�it,��:.L�,'�-�� ��. 12•Z 2-U`� � _ � b-� <br /> Sn�nature Date �� <br />