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ELECTRICAL PERIVIiT APPLICATIrN <br /> CITY OF E�'ERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 ��"Ib-�� <br /> 425-257-8810 - FAX 425-257-8857 -www.everetlwa.org �Do1i2 �9 � <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> lll .� /��lr, 7, r� ,7 iT_ <br /> PROJECT ADDRESS <br /> ���5 7`/`% <br /> /2 ��r ',�'C�,r C u,,57:,��T. , r �rr, ,.l`f uY� `7�7� <br /> Ownar Atail Address Cily Slale/Zip Phone <br /> � <br /> 7�i�� Mail Addruss City Slale2ip Phonc <br /> � F� r SI�cP 1j rr r-� �~� �- <br /> (�< 7 ,-i I�'� f1 F/r� T/ [ ���'�G G�7h i7" it� ���j� 3�Gy �%/ � <br /> EIO�I Cuniteclot Mail AdJress Cily Slale/Zip Phone <br /> ��uZ��l 93� l. :T �,�c� <br /> Slate Uconso Numbcr Contracl Prico o(Work <br /> ,�� « <�xsT«, T.�--� /��s.��,., ;�r� n�., h,�,,lci. :� � <br /> Proposed Use ol l3uildin9 Contact Parson (Plan Revievr) <br /> Description o(Work lo Oo bnno: ��f.�_ LU.�S�/�u[T•��� <br /> NOIE WII:ING IN NON-DW[LLINGS IS RE�UIRED TO fEE / <br /> DE IW RACEW�YS, MC OR AC CA�L[ 1 n <br /> �I �� <br /> CITY OF EVf.RETT LOCAI SALES TA%CODE IS 3105 <br /> I hernby crrtily flmf I ha�o rcad nnd exarnineJ this npplkafion r+nJ kno�r fhe sernu lo bo fine end <br /> conrcl. All provisions u!la�rs end on6nana�s p,�vormng fhis fype o/eark �ti�ill Go complofeA <br /> whefher sprrdied hi�rem o�nnt The granfinp rl n pornuf Aoes nof'nesumo to givo aufhonfy f� <br /> violafc or r,uic�l flu�!norisions ol eny ofher sfate or br,nl Imv m�u ahng consfruction or fho <br /> perlormam ��ol ronstrucfiun. Thaf 1�m eufhorized by�fho o���ner o/fhis property fo peAonn fhn <br /> �roik loi n r�ich;inpl�cnfiun is m��e and 1 conq�ly wifh fhe Sfafe Confinctors Lnw 18.27 RCIt'anA <br /> 29G2001tAC. � <br /> �� �% � <br /> ��� .:,, ;. ._ �j � <br /> ��' Sipnalurc ----� U te �� <br /> 1� �� ( , <br /> i <br />