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Sep-24-10 12 : 12P P.O1 <br /> ._� _' <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREE7, EVERETT, WA 98201 �'1 `-a y `�d <br /> 425-257-8810 - FAX425-2!i7-8657 -www•evereltwa.org C /�o�`�16 <br /> APPLICl1710NS ARE ACCE?TED FROM B AM TO 4 PNI <br /> --��19 �'z vcr�n, �1�i-- <br /> PROJECT ADORESS <br /> Cc�.1G� I'fOV��. — CO�t�� �,�s�L ��.Dd./ <br /> �ain2q> ahone <br /> Owner hlail Atltlress �dY �� ��O <br /> Stf1j2.Lfc�' C GiDtS I/,P• <br /> �lon.m�u C_ � �L� ._q Kyck�fN '�(� 9�dor_.__ zs P�� <br /> Tenanl !.1ail t.ddress Cny Slate�7iu I ,�� Phone <br /> t/ <br /> ���4nr�n�_ Ser S.. 3�or ti b ,�_f�l . �'�'�e�i �s'� �/�c/ <br /> EIOClliG21 COntratk�r A7a�l Address City Sfatc+Zip /� Phone <br /> �rf�-�Nrs��Z �/� _ _.� �� ��h�,�f <br /> Stote Licunse Number Cuntract Price of W urk � <br /> �01U(��1 <br /> ProposoA Uso ni Buildin� GOnlat�Pe�son (Pian Rovfow) � <br /> Description of Work to C�e Oone� . G�ICI-dK L/ I�f �S�C U2/ � �/ � <br /> C,l�l C�U��� F.��l 0 �� / L � <br /> ' �'�/1 C v/T' �' <br /> � <br /> NOT[: WIRING IN NON-DWELLINGS IS R[QUIR[D TO FEE <br /> OE IN RACEWAYS, �1C ORAC CADLE. <br /> 90 � <br /> � <br /> . <br /> dTY OF EV[RETT LOCAL SALES TAX COD[IS 3105 �U � <br /> I fiereby ce�liry l�iat I ha�•e read end eaammed tlris epplicafion arW knurv Ihe senie(u Le true and G � <br /> conecf. A!I provisiens a/6��5:s:�nd rndinuncos yopNminy lhis rypp �!�sak w,R be conrpleteA � ♦ <br /> nhetfier spea6eJ herein or not The yruntr��p a!a permd ducs nofYresume to grve aufhonfy 1n <br /> vw�ate er cancei Ihe prensions or any olher stafe or lucallow reyu elin4 cvnstructiorr vr Ihe <br /> porf<�rninnr,ia�f const+uciion. 7hat 1 ant authorized Uy fhe owner o�'(hrs property tu perfonn the <br /> wark Inr�rhich npplicaGon is made and i cw»pfy�rdh llio State Cwibactuis f_aw 18.27 FCW anu <br /> 20G.200 6141C. <br /> ....... .igna��M�=--�--!___'_ Dat? 7 � � � l; � <br /> � ' <br /> I <br /> I_..... .. .. .._ . . .. . .__.. . _ . ._ ..._ . . <br />