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OCT-26-2010 00:13 From: To:2578857 Paee:3�3 <br />ELECTRICAL PERMIT APPLICATION <br />. EITY OF EVERETT pERMIT SERVICES �_a�_� <br />; V' 3200 CEDAR STREET, EVERETT, WA 98201 � <br />425-257-8890 - FAX 425-257-8857 — www.everetlwa.org �/O/"D-�59 <br />APpLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />( 5 S, c�J -�ve�-e.�l- i'l/�ct-�1_ 1,�1 �' <br />PROJECT ADDRESS <br />owner <br />Mail Address <br />Mail Atltlraxa <br />Elecfrical Coniraclor Mail Atltlress <br />So�rTP ��'��D7 <br />State Ucensq Number <br />o�► c�. <br />P�uposed Usa of 9ullding � � � <br />City <br />Cily <br />city <br />Stale2ip <br />Sca�c/ZIp <br />Stale2ip <br />, L'�&Mnc <br />•T <br />yZ -IISI <br />Phnne <br />4� � 65C <br />Phone <br />� 3,�.�� <br />Contract Price of Work <br />�or, SY�.4-��r <br />Contar� .t Pereort (plan Review) <br />NOTE: WIFING IN NON-DWELLINGS IS REQUIRE� TO <br />BE IN RACEWAYS, MC CR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />y ced/ly Ihot I havo read and ezarninod (hia epplicalion and know �he samo fo ba true and <br />All provlsions of /aws end ordinances govemmg ;his lypa of work wi116n r.omploted <br />r specified herein or not. The grnntlnp o(a penrnl dUos not resume to glva aufhority to <br />or cence/ the provisions o/ ony other stale oi focal �ew repuPafing consWction or the <br />�ance of eons(rut�ion. 1'ha! 1 em uuthorized 6y �he owncr ol thls p�operiy (u pedorm the <br />i whlch application !s made ond I com�ry with the State Contractors Lew 98.2% f1CW and <br />� wa r. <br />�._...., �, l�...)'• �� � ^ uaie . <br />11�U-� cc,e.Q_.4 4 a5 �! � , <br />c <br />i-(� �,u.�,�-' UY�'tou►�' � �rti <br />--_____ _...--��------ _ a <br />FEE �• <br />i <br />�t� l c� —is�( <br />