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SEP-10-2009 01:44 F'rom: To:2576B57 Pa9e:1�1 <br /> � <br /> ' \'�. <br /> , ELECTRICAL PERMIT APPLICATION <br /> ,. CITY OF EVERETT PERMIT SERVICES �� �/ <br /> ��' 3200 CEDAR STREET, EVERETT, WA 98201 <br /> ' 425-257-8810 - FAX425•257-8657—wwW.everettwa.org 9 ��D-09 <br /> . APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM C(�5'DC� �Q 3 Z <br /> 3d o a Co (��l �-� . <br /> PROJECT ADDRESS <br /> Owncr Mail Addioss ` City StatGZip Phcxie <br /> /1 <br /> �,Iv.Ca��;�-lsi SQ.�'l� <br /> Tenanl Ma�i nddress <br /> ���Y State2ip Phonc <br /> �r�-ro� K�' �ic �� l ('a��. ��,� �il�D'P� I� �jK7ol ua �hSS <br /> Electncal Conlracror Mail qddress Ciy Sl,tartiv vhonc <br /> So�rrP ��'��D7 � <br /> State LiCenso Number ConUacl Prico of Work <br /> d�� � �P� 5�� <br /> Proryosnd Usn of L�wlding Conlect Person (Flan Roviow) <br /> Doscriplion of Workto Be Done: I �1 y�J I� <��}"(�l9 5`��� <br /> _,�.� � <br /> ca.n�a l ;c; s n ro n��}- <br /> �XrS�i� v� c.ea ' <br /> NOTE: WIRING IN NON-DWEI.LINGS IS RE�UIRED TO p�� <br /> 8E IN RAC[WAYS, MC OR AC CApI.C. <br /> CITY OF�VER[TT LOCAL SALES TAX COpE IS 3105 <br /> 1 here6y c,rti(y(haf I have reod and examined fbis ap,olicafion and know Ihe sema fo he frue and �����"�j,Z <br /> correci. A/l provisions of/ows and nrdinances gnvemmg this ty pe ol wo�k will be compfeted <br /> wAether specifird hereln ar noL The qranfin�ol e permif does nol prosurne fo pive authonty to <br /> violale ur eunccl fho provisions ol ony ofher s(ate orlocol IAw regulating consWe(lon or the <br /> peAom,ancc ol consinrcfion. That l um aulhonzod 6y thc oK�ner of th�s propeKy fo perlorm tha <br /> wo�k for rvhich apphcation!S matlATnd 1 comply��4fh Ihn Sfnle ConUac(ors Law 1H27 RCW and <br /> 29ti.2 WAC. <br /> I lM.x-�� <br /> Ignaturo DatO <br /> �l�e cc.e�.4 4 2�5 �'? ) -as�-1.� ��,er�' ��" <br /> �/`V ` <br />