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09/2?/2010 WED 11:24 PAX C258203487 Greenwood Neating 6 W C <br />mooziooz <br />ELECTRICAL PERMIT APPLICATION <br />ClTY OF EVERETT PERMIT SERVICES � y�g �� <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — wvwv.everettwa.org / <br />09-/� <br />�io <br />APPLICATIONS ARE ACCEPTtD FROM 8 AM TO A PM <br />2pz1 Lekinq{on AVe. <br />PROJECT ADORESS <br />Owner <br />Tanan� <br />A1ailAddress <br />hlail Address <br />ElecUicalContraclor MailAddress � � <br />aSYOU,YWq'?S�NM <br />State License Number <br />�qk �Fur►��it� rea�dc�.�h'r�. <br />Prop Ue�c 1�i e of 6W�dinc� <br />Description of Work to Bo Done: <br />NOTE: WIRING IN NUN-DW[LLINGS IS R[QUIRED?O <br />8E IN RACEVVAY3, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SAIES TAX CODE IS 3105 <br />S �V� �' � <br />Ciry SlatelLip <br />Cily Stale2ip <br />425. <br />�.S ►4 <br />r'honc <br />Phone <br />Gty State/Zi0 Phone <br />� 3�c�,'� <br />Contract Pnce of Work <br />hac�ic_I�acr� <br />Conta Person (Plan Review) <br />I hereby cortity that I have read and e� �ied this application and know the same to bo fnro and <br />correcL All provisions o( laws and orn�. „es govsming lhis rype o/ work wil! be co,nploted <br />whether specilied hemin ornot. The ,q: �'�nting o/a permR does nof presume to glvo authority fo <br />vrolafe or cancol tho provisions ol any other stato or locnl law ragulating consfrucLon or Ne <br />pe-rlonnance oJ conslruction. Thaf I urn authorized by fho ou�ner ol thrs propvrty to perfo�m tho <br />v+o�k lnr �vhi;h application is madc and f comF�Y �5'i(h fhe Stato Confracto�s Law 18.27 RCW and <br />29G.200 IM1�AC. <br />. iiYl� �l J -r1 � �1 � !o <br />FEE <br />C..� �'�'�� - � �Lf <br />