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JUN-01-2011 �9:40 Fror�i:LNP 8686159679 To:14252578857 Paee� l'4 <br /> � <br /> ELECTRICAL PERI4PIiT APPLICA�IC�N <br /> CITY OF �VEREfT .PERMIT SER'VICES <br /> 32�0 CEDAR STREET, EVEREI7. WA 98201 <br /> 425-257-8810 �- FAX 4"15-257-8857—w�vw.everetiwa.org <br /> APPLICATIONS AR�ACCEPTED FROM 8 AM TO d PM <br /> 5 � - een L.). G+�',uefl f..ila �b'�03 <br /> PROJECT AD RESS <br /> C� S���p Phone <br /> Owner Mail Addmss <br /> �tn 5�17 � , C.�? r `IY�t�' - i7o-C-•l�a <br /> C� S���P Phone <br /> Tenan[ ail Address <br /> Me�-rn ���c�-� 1LL 3a33 Is� la� S �/�5 �xa�"C�c l.ala 98/3`I �ti3- 3v�1-P� <br /> ElecUical Contractor <br /> nn�a naar� s���er�a <br /> � <br /> MG iRoFL 9 �! O� co v r��erw <br /> St�le License Num6er <br /> �US� �i ,n..�^^O• <br /> � �" '"� Contact Person (Plan Review) <br /> Proposed Use of Buildi�g <br /> l , ��.�( �rl� s �- ��.z� �l.f�� � �. <br /> �escription of Work to Be Done: _ (?�:�,' � <br /> �, ' • G l fb� <br /> ,-� <br /> l <br /> i <br /> i FEE <br /> � NOTE: 1NIRING IN NON-DWELL�NGS IS REQUIRED TO <br /> '�I BC IN RACEW�iYS, MC OR AC CA�LE. I� ��. �� <br /> CITY OF EVERETT LOCAL SA4.C-5 TAX CODC-IS 3105 �i � �,�.-� <br /> !herebY certily that i have�ead and Cznmined this cpplication and know Oie same to be We and �%L� <br /> comect. All pravisions of laws�nd ordinances go�eminp fhis fype o(work will De.comp!;tad <br /> whefherspeci�ed heiarn oipot. 7iae gr.±nHng of a pertmt does not presume!o grve au�iionry to <br /> violate or cancel the iovisions ol any otner state oNacal law regulating constme}iun or the <br /> peAormsrtce ol con��rucfron. Tifat 1 sm aufhonzed Ay the owner ol!his proDeKY��Pe�a�the <br /> work(ort hich apql�caLon is mstle and 1 comply vnlh fhe Sfate Contradors Low 18,27 RCW and <br /> 296.200�AC. � <br /> ,/ (� � .. �_ /� <br /> _-�,' -` o��e <br /> SignaNre <br /> / <br /> ( <br />