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08/22/20�7 13:02 4253538934 EVERGP.EE�J SECURITY PAGE 62/02 <br /> R <br /> r <br /> � <br /> ELECTRICAL F'ERMIT APPLICATION <br /> CITY OF EVERETT PERIIAIT SERVICES Q`a.��� <br /> 3200 CEDAR STREET, EVERETT,WA 98201 ,. <br /> 425-?57-8f310 • FAX 425-257-BB57-www.evere;twa.o�g �0-7b��S�O <br /> APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM <br /> ag�� ��y �E <br /> PROJECT ADDRESS [�� 3�/�,��� <br /> � T <br /> �(-tu- cav�F' I�LlSSf9l� o�gl�{ �.{11�g v�f'-�i�' S"?1J � <br /> Ownet Idalt Addrefe eity Stere/Zip Phone <br /> Tenant MBilAtlarees CAy Stete2�p ��1]oAe� <br /> (�b <br /> �;��.� �c.ue�Tr�l _ f�l�s 8(lo�l'DWf{� '�l�i � �2v1 3Y8�-3 � <br /> ElechicalConlredof MatlAddr es City Slete2�p Phone <br /> �V1�12Cas�ll�l,2� ���9DD.�O — <br /> State�icense Number Contract Pnce of Work <br /> �h�rt� � s <br /> Proposed Uce o�8uildinp Contaq Person ( lan Review) <br /> Description of Wark to Be Done; ��Y��I�,d� ��1 � �� �� <br /> L� um�e A2�'� 1a�cv►c�-s . <br /> NOTE� WIR�NG IN NON•DWELLINGS IS RE�UIRED TO FEE <br /> DE IN f2ACEWAYS, MC OR AC CABLE. ��� O j� <br /> CJ <br /> CITY OF EVERETT LOCAL SALES iNf CODE IS 1105 <br /> I hCreby sE�iify fhal I have read and exsmined fhi9 Applrcatio�and Irn�r;fhe sanre(o La froe Bnd <br /> corred. All pmvlsions ol/aws anAordinanres po�reming lhis t}7�e o/woilr wiit ba completerl <br /> whefher epee%fied herom or n�L The yrannnp r�e pe�mit Coes nOf presume lo qive aufhonty to <br /> violafe or cance!Ihe provislon,^ot any other slafe or local!aw reauleting cor,�frucfion o�Ina <br /> peAormance of conStnrc!�oh. That I am aUfhpnzC+d by fhe owner o/fhls propr,Ry!o perform(l�e <br /> vrork far wbrch application is matle ontl I cemp!y ivith the Sta!e Contracrors Law 18 27 RCtN and <br /> 296.200 Wi+C. <br /> ` � _ <br /> 5� naWre � �v � <br /> � Ea�o�-�5� <br />