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02/lll/2007 09:G�6 4257751960 :ACTI'JE EIJGIIJEEkIIdG P�GE FJ2!02 <br /> � � <br /> ELECTRICAL P�RMIT APPLlCATION <br /> , CITY OF EVERETT PERMi i SERVICES � --� --c� 7 <br /> 3200 CEDAR STREET, EVERET(', WA 9£i?.01 � d-��.��� <br /> 425-257-8810 - fAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM S AM TO 4 PM • DGOIT 8 CREb17 CARDS ARE NOT ACCEPTED <br /> I 13 l 5 � Z�bers on D� <br /> PROJECTADDRESS <br /> uob W; nsl-��_ 2�111 10�1'"`��{5� CJere�' _ <br /> OWI7Cf Mail Addre70 Clty Stale/ZIp Phone <br /> Tenanf IdpllAAtlreso Ciry Sln1e21p Phane <br /> �J25.�-'fo. gli`Tk 18 <br /> �GI-;J �t 'n e ;r��05 2D6�"' S�- �u1 Lyr�ct�a,71?� I.J/� �go3Le <br /> EleqricalCoNroct6 �h��allAddress Clry s(ate2ip phonc <br /> Ac.4-;ve-� OfiBms � (n0o. pp <br /> Stato Llcense Number � Contred Price of Work <br /> • res�_den-1� al <br /> Proposod Use of Building Contact Person (Plan Review) <br /> De,criptlonofWorktoBoDonr. 11n5-1-a1 �O p ��QQ_ {�-�����_e�� -4-�MpO(Q" <br /> seN� CC� � <br /> NOTE: WIf�ING IN NON-DWL=LLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> � <br /> CITY OF EVERETT LOCAL SALGS TAX COD[IS 3105 <br /> !hereby cortily(hat I h3vo road and ox3mined this applica�lon ond know tho samo to 6e true ond <br /> corrocl. AU provisions oflams an�i ordinoncos r�ovomin�tAis type of�vork wi�l bo comp/ofotl <br /> whethor spoalicd haroin or noL q�o r�ranfing of a pomnf doQs not presumo to,qivo authonty to <br /> viofato a cancel fhe provisions o/any pprer stnto or/oc�l law rogufafingpcvnsrruCtion or thn <br /> �ewk for inhl ch aHpllcat on�'s�do and I complv��7h 1he Sfa7e Contrarc(orNspLo�1R 2i�RCW a�d <br /> 29G.200 WAG. <br /> _ at�r� 2. I . � <br /> SlgnoWrc Do1C <br /> 1' G7G.�-C�G� <br /> , <br /> � <br /> _ _��. L �/L' � ���,,, . <br />