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_ .� --_ ."____—" . ._ __ --_—_.. _ __' <br />c;c:�. P�I `�l P /J 5 <br />� i ��'� ����li <br />ELECTRIC�AL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREE"f, EVERET'f, WA �J8201 <br />425-257-�810 - �AX 47_5-257-8657 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �p <br />��� <br />''1102-� ��E��n Wc'^1 <br />PROJECI'ADDRESS <br />Owner <br />� Ulte� IeC <br />Lleclrical Contrae�or <br />Mail Addmss <br />�10Z� Lwl�%�UYI <br />n �(c� � �,ve.,�e-1k�1�� ��aD3 ��S)a�oS-18£s� <br />City SI. tcl7.ip Phonc <br />�1.�VeVeH,W�.�1��3 l,��a5)�1a5- I���b <br />MailAddress � ���Y <br />���1nc � �,t�3 �� Sk•�w��Y�'�,�'� <br />M2il AtldrC55 <br />U!�M�L�iSz��� J/z./�� _ <br />Stale License NumUer <br />��Y�vr'� .Y/�l'��L'fi`1 <br />Prrv;osed Use of uildin� <br />Descriplion af Work to 13c Qonc: �1�� <br />Slatc/Zip <br />is <br />Phanc <br />Z535 �US- KfS��I <br />Cily SWte/7ip Phane <br />���� <br />Contract Price o( `Nork <br />�/Yb✓� N`C�l�i��i�- <br />Conlact Pcrson (Plan Review} <br />��tv (2) CI ��`h <br />��ti� �'� � — <br />-� <br />NOTE: WIRING IN NON-DW[LLINGS IS REQUIRGD l'O <br />BL= IN RACEWAYS, MC OR AC CAl3L[. <br />CiTY OF EVERETT LOCAL SAl.ES TAX CODE 13 3105 <br />1 hereby r.crti(y (hqt ! hme m,nd nnd exnmined fl�is aipplicnlion andlmnw Ilic snmc lo Y,e (nro and <br />co�rer.l. All pmvisinns o/lav�s and ordin�nces �overninry O:is fl'pc ol �•�odc �vill be completed <br />�aDefherspecilicd hercin ornol. The grnnling ol�� pemid docs nof uesumc In givc auflloiity fo <br />violafe or canr.el lha �rovision; nI nny ofhersfa(e nrlocnllnw icgulalin� caishuclion ar the <br />perfonnance of r.ons�ruclion. Thaf 1 am aulHorized by fhe o��merof (His properly lo perforrn tlte <br />work lor�vhich applic�finn is nmJc and I comply �•�ifh flie Slafc Conbac(ors Law 1ti.2% FCW nnd <br />29G,200 W�C. <br />�% D�G�I-wl� <br />�Sig tur��----_— Datc <br />FE[ <br />[� n V Z—' �I <br />