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� JUL-22-04 THU 09�21 AM E�"FTT PERMIT SERVICES FAX N0, � 257 8057 P, 02 <br /> EL�CT�ICAL PERMIT APPLICAT'ION <br /> CITY OF EVERETT F�ERf1AIT SERVICES <br /> 3200 CEDAFt STREFT, EV�RE77, WA 98209 <br /> 425-257-8810 - FAX 425-257-8857-www.everettwa.org <br /> APPI.ICATIoNS ARE ACC�PTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> I <br /> 5 3oZ-�,�e�-��, (J�.e.� ` ���exUe-t�— _�L�zA-Z ��-er�-e�� �w4 <br /> PROJECT ADDRESS <br /> bv�e��r� <br /> �r��- vr��.��q-� , 5�d2 ��eac �� � � ��ev,�- �_I R� . <br /> Qwncf �� Mail Address Clry StatnfLp Phone <br /> � � <br /> Tenant Mail Address City Slatal�ip Phona <br /> �� � �-1 �� � 5 3� <br /> EIeGrIC31 Contractor Moil Address City lateftlp Phane <br /> Ow r N�� S � `15 'N � �I ��d�tJ6 � 1 � 0 b <br /> State Llcenso Num4er Contract Prico of Work �(��' <br /> � ���P �`c-t i�r � lx:�c�e '�J Q-a� �.1At�V <br /> Propo�od Usc of Building Contact Person (Plan Revlew) <br /> Dascription ot Woric m Be Done: � E �� ( � � � <br /> � I��.�esC�--� �,t.Q-�-l���� ►,i� uni P-C ��e �Ren� c7�' �leQe� <br /> ��r z��-- � ��`" '►�y� <br /> �Q.4�e �.CQ ttit,�-� 3,3 Ce�t•*�Qs <br /> NO'fE: WIRIPdG IN NON•DWELLINGS IS REQUIRED TO �� <br /> BC IN RACFWAYS, MC OR AC CABLE. <br /> CITY OF EVERE77 LOCAL SALES TAX GOUE I5 3105 <br /> I IieYeby certily thqt 1 havo�oad and oxaminod tl�is applicatlat and know the same to be frve and <br /> correct. A!!provisiana nf fnws and ordinanees govoming this type of work will be comple�ed <br /> �vhether sper.i/icd horein or nol. The granting o/a ponnd does notprasume to pive authority to <br /> wp/ate orcancef tne provlsfons o(eny oiharstata orlocallaw regulating construcHon or the <br /> performancn olcens7rucflon. That 1 am authorized by ihe owner of Ihlsproperty to pa�fonn fhe <br /> wurk lor which applicotlon ls mndc��nd 1 compfy wi(h the Stata Contrac(ors Law 1A.27 RCW and � <br /> ��s.znn wac. • <br /> ��(j�'JC� <br /> ' , �—��--vYa�� r, <br /> Siq�turc Date <br />