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RI•1E PAGE 02/03 <br /> 11/06/2012 15:59 2088531A18 � <br /> ELECTRICAL PERMIT APPLICATION <br /> C�TY pF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 67 _ /2 <br /> 425-257-8810 - FAX A25-257-8857—www•everettwa.org �I — <br /> �Zl� -D�( 7 <br /> i�"pLICAT10N5 ARE ACCEPTED FROM a AM TO 4 PM � <br /> � �verc�r e er� w o. <br /> PROJECT ADGRES <br /> (�` �SU'L� �DOC� ��U�'Q.T �,�-ISv F I�ornrnarC ���O �k• YYIE�-� �i�N_�_ 1� �319`�Z <br /> Owfler Meil Address Ciry Stat�p Phone . <br /> (2o�s)88� - (qolol <br /> Tennnl MailAddrvcs Clry SloWlfp Phono <br /> �mG I+n� Po �ox i�o�sZ ��s� ib ��7 i� <br /> —� State2ip PhOno <br /> e�actricai ConUaetor Mail Addresa �' �20k�B53-ZQ�8 <br /> Y�YY1 E i N 1 �W�t�LS �,Co .u9 <br /> State License Number Contract Pnco ol Work <br /> T�r �we-r�, <br /> Proposod Use oT Bulldfng Contact Person (Plan Review) <br /> Syuare Footaga(If rocidunGal naw consW cGon,remodel ur nddi6on) <br /> Pescriptlon oi Work to Be Dono: �l T 0 1 l� �oolQ � �I oo r 11��� � L��s <br /> �s` � <br /> F <br /> NOTE: WIRING IN NON-�WELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS,MC OR AC CABIE• . d+ �3 5v <br /> ip <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> !hereby certify tha!I hav�read and examinod this applicafion and kno�v fhe samo fo be frue and . <br /> cemccr. NI provlslons oflaws and orcl�nances govamfng thk typa of nroric wil!60,comploted <br /> whothar spoc/flod horoln or noL The grnnling of n pormd does no!prosume ro give euthonty to <br /> violato ur esncnl tho rovicionc of any othorstatn or(ocal law rogulafing oonslmotion o�tho <br /> perfonnenco of consPruction. That I em authanzad 6y!ha ownar of(his roperty to por(ami lho <br /> work!or whlch oppllcotlon Is mnda ond I comply wltb tho Stofo ControcPrn LoW'18.27 RCW ond <br /> 286.200 WAC. <br /> � l v <br /> IgnaNre 1° <br />