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Oa/03/2013 12:ad 253-631-775a PROVIDENT ELE�TPIC PA'SE 0°J02 <br /> - --- — — —. . . I <br /> ELECTRICAL PERMIT APPLfCATION i <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVER[TT, WA 98201 <br /> 42s-257-8810 - FAX425-257-8857—www.everettwa.org <br /> ! APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> � --- - -- — -- -- - i <br /> 991� �Sr�C, �,J � <br /> PROJECT ADDRESS I <br /> _���_��-�7o-TK1{_�s ��HyZS �Il �c.,cGc Ca�4/`TS[�L 925-7fc8-9+-(Il � <br /> O•.vner �V�✓Vw lAnil Address Cify State2ip Phonc <br /> I _ ___—_ __—.�_.—_- I <br /> i Tenant Mail Atldress Ci(y Siale2ip Phane <br /> � <br /> '�s3�Ci��r_i�1��°�'��6�7_��Lqt'on CJlI/`�80�{�SS'CDSI'77 <br /> ❑ecMcal Contractor Mail Adaiess iry State2iv Pnone <br /> i�'(�Od�£SlO�GZ ____ <br /> State license Number Contract Pnce of lR'oik <br /> � (1P�Lt)5 f'✓14�� C�1+'� � i CPi �1i vt/�,r1 i�il� I <br /> Proposetl Use or � nding Concact Person (Plan Rsviow) � <br /> Uescrplion of Wnrk to Be Oone� ��_�D �V�GC�_�� (��✓1 � _ <br /> � (�- - <br /> _�l._P��lrl��.f�� vli,�� rT�Si�+GG _ <br /> ; T <br /> � <br /> —_ _ - - -- — ' <br /> INOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE ///��� � 1 <br /> � 6E IN RACEWAYS, MC OR AC CA6LE. �O I <br /> � CITY OF EVERETT LOCAL SAL[S TAX CODE IS 3105 I I <br /> � i hr.reby ceRily thal l have read and exarnined th�s applicatiun and kno�v!he same to Ue trve and .- � <br /> IcorrecL A'I provislons ol laws and ordinancos govemmg lhrs rype of riork uaU be complefed L, � -���, l�._ C, t(� <br /> •,hetnor specrfied herein or not. The grar�6np ol a permd does r.ofp resume fo give aufhonty to j � <br /> I violate or cancol fhe provis�ons o!any othei stafo or local law regulating const�uction nr the '� <br /> IpeAormance of construcLon. Thaf 1 am au;hnnzed hy'he u�vner of this properiy to per(orm,he I <br /> •.ti�ork lor whmh applica!ir,n is made antl f r.omp,�y�;aLh!he S1ate Contracfors Law 7827 RCth'and <br /> )96 200 1N�1 C. <br /> I '���" - — . APR0� 2013 - - -- <br /> gnawre Date <br /> � � <br /> I <br />