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A'JG. i. 2ii12 i1�: 53AV 1EiVEnSA4T 1�. 7;�; �. i <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVER�TT PERMIT SERVICES <br /> 3200 CEDAR S7REET, EVERETT, WA 98201 ��7 —I 2- <br /> 425-257-8f310 - FAX42�257-8857-vnvw.evereriwa.org <br /> C i�g-oa3 <br /> APPUCATIONS ARE ACCEPTED FROM B AM TO M1 PM <br /> J�h �i1'Ra� �E�E�;hh ,Ev�nEr, .1a�1 q��3yt <br /> F'ROJECT ADDRE55 <br /> Owner Mail Addiess Cily slate2lp Pnene <br /> ��i� �.MRn`-INFM �TcGU'(���u .P, �A St-i�-�\4�1't yS'it 4�� . I-�C2�.-��t � L,1�`�g 'l <br /> Tenan� Mail Atltlress Cily SlateRip Phone <br /> �E'��6A�1nrc �T�uS �.Q'>`���1oM+�s ylve V,1 Q�cx�� 1,���bb5'� � ��4 �IC1P <br /> EledriC21 Contrador Mall Adamas Ciry Slate2lp Phone <br /> �c�►�..��q�.�� � 2,s� , _ <br /> Stale License NumDer Contract Price of WorF; <br /> ri r� � 2 �:� r� C, Ic�� ����-� <br /> Proposed Use ot Bw ding Contact Person (Plan Review) <br /> �Go �� <br /> Squar�Footage pf residential new construetion,remodel or atldiUon) <br /> Desuiptlon ofwork to Be Done: ��OV�ZF � 1NSi�AI..L_ �Q�Q�Y.\KE i L� !\� ,�(Z`� <br /> 'C\�1vS ���i� ��-��1.�1�9r—L�OW��_ <br /> NOTE: VJIRING IN NON-DWELLINGS IS RE(1UIR[0 TO FEE <br /> BE IN RAC�WAYS, MC OR AC CA6LE, <br /> CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> I he�eby ceriily that I havr.read and examinvd this appllcafron and know fhe same fo be true and <br /> correct. A:l pmvisions ollaws and nrdinances goveming this t}pe of tvork w,7/be comp/efod <br /> whelher spuc�fioU lierein or nof. 7he granGng of a permrf does notp msume fo p'rve euthon(y to <br /> viola(e or cancel the pruvisions of any otherstafe wlocallaw regalating consl�uchun or fhe <br /> perlormanceolconslrucfio.a. ThaUamauthorizedAylheowneroffhispropertylopedormthe <br /> u•ork for�rhich appfication is mado and!comply�vrtl�fho Stafe Confractors Law 13.27�RGW and r <br /> 296.200 AC. y j�o�-�L3 <br /> /� - � '" �o� <br /> '�gi alure Dale <br /> t I <br />