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03/22/2011 08:21 2532888718 FEDEX KINKOS 1868 PAGE 02/03 <br /> / <br /> 1 <br /> ELECTRICAL PERMIT APPLICAT�ON <br /> CITY OF EVERETT PERMIT SERVICES 3 _aa�� <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857—www.everettwa.org C I I 0 3�77 <br /> APPLICATIq VS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> 1031 G F����ev� 1.J��[ �v�re �-�- wA- 98ao�� <br /> PROJECT ADDRE�S <br /> 'eSt.__ Lh.F;�z Io316 Eve�vteen Wa .� �iCre{'� (.Jh 98�6�( 4d5-43f}�937 <br /> OwnOf Meil Addreas �— Clty State2ip Phone <br /> rie� bz (-ah��,a �Us14 C•u�te� wa �c�l'e�-f' ,�, �,� 9eaoy il�5-y�4_S�7 <br /> Tenant MailAddmss �— cl�y state2�p Phone <br /> n��-�� CIP�!•��•� i�c a��;a-; �+Fq�S '�1v5 jeal-I-I� � ��1 `J8�� 4 a�J 304 5$ <br /> EledricalContraetor MpilAddress Clry Stele/�p Phone <br /> /� 11�0 _�_ 90� O I� �I�.S� <br /> State License Number Confract price of Wak <br /> r <br /> �� z �� �osl_ 5;�„�...v.,5 ,. <br /> Proposed Use of 0uitding �— Contact Person (Pian Review) <br /> Description of Work to Be Done: �ow�nn.h ; F.,, �a . 'pra, �- I t��'•-� � n�a a� <br /> J r <br /> NOTE: WIRINu IN NON-DWELLINGS IS REQUI�ED TO FEE <br /> BE IN RAC�WAYS, MC OR AC CABLE. <br /> n � � . UI <br /> CITY OF EVERETT LOCAL SALES TA7(CODE IS 3105 <br /> I hero6ycerti/y that I have read end examined this applicefion and know fhe sam2 to be hue end <br /> correcf. All provisions ollaws and ordlnances goveming this fype ol work w111 be completod <br /> whether specified herein or�,.�F. The grenen,q of a pemnt does not �esume to give e��'.tiafty fo <br /> violateorcanceltlre provisionsofenyothersta(eorlocallewreguPtingconslnictionorthe <br /> performence o conSirucOon. Thet am au[horized by the owner of this properiy to perfom�the <br /> work/or hic appllcation ic mede ntl!comply wifh the Ste(e Conhac(�rs Law 18.27 P,CW and <br /> 296.7.Op A . <br /> ' s;a���� oe,� ^ <br /> ��D� —r��7 <br />