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� <br />s <br />ELECTRICAL PERMIT AP�LICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 9II201 <br />425-7_57-II610 - FAX 425-257-8857 - www.everettwa.org �„ a S- (!..( <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �/(��„�5� <br />�� � � �/'P�-'� � . �P� . C�-/�i <br />PROJECT ADDR[ S <br />C:•+ner <br />`1' <br />Electr�cal <br />Pota�� atldress <br />Moil Address <br />�10II AdOrA55 <br />. -!�'�-- �2��t��i�a`tJ� <br />State L�cense Number <br />Pioposed U;e ol Budd�ng <br />Square FoolBgo (If ro,ioonUal now con.truclion, romodel or add�tipq) <br />Gry <br />Gly <br />CIIy <br />� 9�; � . <br />Slato2lp .� ?none <br />SIa1P/Zip P��cen <br />��- �►��-asa� <br />State2lp V Pnore <br />� a�o <br />Contract Prcc of Work <br />�a'�� ���'S <br />Contact Person (Plan iew) <br />Descnption ol VVork l0 6c �onc: ` '� �'�� �1 F'�Q4�e-ti �,q�—` C%t ��� Q�r�-�S'_.�� <br />G,a,2��c5-_.�_c�—�� _ � -'��r,_ �- ��_k� L�rn� . -- <br />NO'(� VJIFING IN KON-DWFLLINGS IS RFQUIRFD 70 fLE ' <br />CiF IN RACFWl1Y�, MC OR AC CAHLE. �O� <br />CIiY OF �VERETT LOCAL SnLES 7AX COUL" IS 7105 - — ---- <br />I he�eby certrfy Lhat � ne�n. reed ontl eromrnetl ihrs apphcelron antl kno�v fho same fo ba trua nnd � I�O �— I�� <br />cormcl All pmv�smns ol laws nnd ornrnnnca5 gov�rmng fAiS rypo ol wak vA�l bc ccmplofed <br />whd(nni apocmed ne�oin or not. i�p gianting ol a permrt docs notPmsumc fo givc aufhonly fo <br />vlr,IatC or cJnLol fh0 provi5ion5 e! any other stote or fncnl Inw myu o(my r.onstructinn or Ihe . <br />peA ce ol consfrur.han Tha! I am rvulharivnd by tho ax�nsr o! thr� p�Ope�1}� 10 p9rto�m fhe <br />w_�h app�¢uhon �s made and 1 comply t�dlb fhe SfafC Coniroc'orc Lmv 12327 RCW ond <br />�la�-�I� <br />IQO/IDO d 917,�1 7,96 '.�01 �n�� ytl� 5ui�ra�{ pooNeiae�� Pld '�O�f,O �f11/l'107�/1'L/Nflf <br />