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RPR-12-2010 01:26 From: To:2576857 Pase:2�2 <br />� <br />ELECTRICAL PERMIT APPLICATION <br />; eITY OF EVERETT PERMIT SERVICES <br />, 3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8F310 - FAX 425-257-8857 — www.everettwa.org <br />APPLICATION5 ARE ACCEPTED FROM 8 AM TO 4 PM <br />�v�� Cci• !�'l�"i/lQ ��P�.J �''fV'�. <br />PROJECT ADDRESS <br />P�-r ��n�aer ��- <br />(�wr�er Atail AOdra6e City <br />Tenant <br />Eleclrical Conlractur <br />Mail Adtlreas <br />hlail Addr93y <br />��urTP ����D� <br />Stalc Liconse Number <br />�'i7� ��Ja✓.���11� <br />Pwposed Use of B Iding <br />DCSuiU�ion of Work to Be pono: <br />Stalu2ip <br />Strle/7ip <br />� <br />Phone <br />Phone <br />Cily SlalalZip P�onc <br />�, �-3 y <br />Contract Price ot Work� ,�,�� <br />Conlac' t Person (Plan Ravi�) <br />NOTE: WIRING IN NON•DWELLINGS IS R[QUIRED 70 FEE <br />BE IN RACEWAYS. MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALE9 TAX COD[ IS �105 �[ / <br />1 hereby ce�li(y Ihat 1 hove rand end examined fhrs applicaUon end know fhe same to be truo and �) �� —v� � <br />CO�recL All proNslonS of I<aWs antl prdindnCrs govemin� thls fype O/ viOrtt will bC CanplC(CU <br />whefher SpCClfiod herEin oI not. The granfinp o( A pOrmil does nol presume ta give uuthorily to <br />vlolate or c�ncel the provlslons ol any ofher state or IOtal lew regu/atiny consliuclion or the <br />PCe�lor�Nliicfi ap�licatronJs n,ade pnd�l conip yiv(t fiiH Sfo e ContrhactosL.iw �� 27RG�W�aiid <br />zAs zvp k�nc. <br />- ignature �_�A� � ^ � `" I ?j �l � _ <br />Pl� c��.e 2 � � � as � � �Fo-� �e� ����+�`- <br />� <br />