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May-19-11 07:09A <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMtT SERVICES <br />3200 CEDAR STREET, EVERET7, WA 98201 <br />425-257-8810 - FAX 425-2:i7-8657 —www.everettwa.org <br />APPLICATIONS ARE ACCE?TED FROM 9 AM TO 4 PM <br />�3/`i G�fi%��of2� — <br />PROJECT ADDRESS <br />��_�Ir J� G��% �'`f�.2ro�� ��/ %�da3_. <br />Owner hlail Address City Stale/Zlp <br />P.O1 <br />S-�`��11 <br />� ��05�[ <br />Y�s <br />:� s�� �9yy <br />.__._... Phono <br />Ten3n1 Mail Address Giry Stalc/Zip �2 �r Phono <br />J <br />,�''c/{MCyf,( s xs ��ao� f� t� �c/ Fv �'>or Jsq �_G/ _ <br />Eloctrir.al CoNractor Mall Addrass Clly SIoIMZip Phono <br />f � N SS� y�. L 1� <br />Stato License NumUer <br />St- Iz- <br />Proposed Use o( 6uilding <br />Na�v c�-� C ra,� r� 1 <br />Contract Pricn of VVnrk <br />Conlad Person (Plan Review) <br />CJ��''f� <br />�escrip(lun of Work lo Be Dmie: I�� - f\ V�.J � L. C�S% C//ZC (�/ %��S 1 <br />� - Z C' //rc U/%� _.._---�--- <br />NOTE WIRING IN NON•UWELLINGS IS REQUIRED TO <br />�[ IN RACGWAYS, MC OR AC CABL[. <br />CITY Of• EVER[TT LOCAL SALC•5 TAX CODH IS 3105 <br />! he��:by certi/y tha( 1lrava reaA emd oxarnineA fhis, p�licntion v,d l�now fho samo (o bo fruo �nA <br />cunuce Afl provisions allsws and ordinnnces govemmy fhis t��pe cl worli wrll be cump/efed <br />whcther spec�fed Iremin or noL The grantlnp oIa pennrt doos nof nesume !o g/ve aufhortty fo <br />NMele or cancel tho provisinns ol any other sfafe or focal law mgulrting cunstrucfic�n a tho <br />peAarnence e/ constiuttion. That ! am aufhonzod by fbn o�+air.r nl th�s prcperty fo podorm fho <br />wnrk for �rhlch app7i tiom m�do nnAl comply wdh thu Sfatc Cnn�iactnrs Larv 10.27 RCW and <br />ase.zoo wnc. <br />��i�- - �' / � // <br />�. __......._...------- <br />SiyneWro �IO <br />FEE �B <br />Sv ��� <br />