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1�J/f15/2009 i73: 35 2536392�27 F.EMI_D PAGE 02/03 <br /> �— <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STRCET, EVERETT,WA 98201 <br /> 425-257•8810 - FAX 425-257-8857—www evereltwa org <br /> ApPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM <br /> �?j 1 `j �ci5�- C�S:r ' � 2C� <br /> PROJ[CT ADDRESS <br /> � � <br /> S_�.�er 1►�u, �� � lp� G��q�feen (x1a�#� �Q�C�- ��(� �� <br /> Ownei tna�i qtldress Ciry State2ly Pnono <br /> �-II 31 � �a��r Ca � nc; � �v�r2tFkJh_ , t� �c�8 <br /> Tennnl �dNi Auuress C�ry StateZp Phona <br /> (�{T �'�.) ��`�1..�''�C_ 1 �� � �� .�ir ��'-��J� .�i�' K•Q�';1- �.1�!} ��ik�� ��i.���c,'�{•� <br /> Elecincal GonUaQOf Mall ndtlreee Ciry Slale/Zip� Phnne <br /> ' �. , ic� � � �ll . _ ��� <br /> State License Numbei Con�reet Price uf 1Noik <br /> .��.�,E-.r� �;:t i �t0:i M�.:2 ":� �.✓ti � C�.���Gvd�Y1S L53 B.S��11 <br /> Propowd Use of Bu�lAmg ' Contact Person �Plan Review) <br /> Description of Wurk to Be Dona �� ' 1" 1l�'� �L(.1 E�`�� Q(���I� __ <br /> --- — --- — I <br /> NOl C• WIIIING IN NON-0�NELL�NGS IS REpUIR[D TO FEE I <br /> liL IN ItACkWAYS. MC OR AC CAL`LG � ��j <br /> t�0 <br /> arv or evERErr �ocn�sn�es rnx cooE is ato5 <br /> I 7rereAy ceifily fha(I haw n+ad 3nd exomir�ed(his 2pplrcahon and know the snmo to be[rue nnd <br /> mrrecf. All pn�vurnns ol/nrvs and uni/nan��s goverrung fh�s type o!tcolK wd!�e colnplefetl <br /> whefher spec?reJ henun pr npt. Tbo yranfirn�of a po�mn doas nuf�uesume fo give authonty tu <br /> � violata o�cancv!tho pmvir,inns u/xny ofhcr sfafe or iiK;Nllew myu af%ng�vns6uc6on or the <br /> perlom�snca el cnn5�nrcLun Thsf!am euthor,led by the own�r of Las proFx;dy to pednrm fho <br /> ���nk for v�hi�^h appL�,finn is maAa and I,,��mpq,wifh tha S(A!9 Conbarfcr s Lav 15 J RCW'and <br /> :96,i4jJ WAC. <br /> � / � . <br /> _ ��L��'c�,.i.L` Il� - St�`� <br /> Sipna�uie ue�o <br /> 7 <br /> � �� �:�/G'1,�� 7 <br /> ----_----_------ . __ i <br />