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OJ/:A/Oi TL'E 1J:3J FAS a:5 J55 I810 DLTIO\ ELECTRIC <br />ELECTRICAL PER�IAIT ��PPLICATION <br />CITY OF EVERETT P�RMIT �SERVICES <br />3200 CEDAR STREET, E�REiT, 1NA 98201 <br />425-257-8810 - FAX A25-257- ,857 - wm'w.everetriva.org <br />APPLICATIONS ARE ACCEPTED FROM ti AM TO 4 PM <br />cf+(c�- ��p�( i <br />29'Zo '7Z-ew t�� � f1-c1��o f <br />PROJECT ADDRESS <br />Owner <br />Tenant <br />-t- Z81e <br />btail Atldress <br />A7all Address <br />al� ;�� UC-�l-'riT <br />;c�cy <br />� <br />jCity. -- <br />� <br />�( htfft[C. � � 2�Ui. 1^�UkCl.iE6 <br />Elec1ric31Contractof � ldallAddress <br />'��tiyp�c i3� f� � <br />Slato License Number . <br />���( C�.�- <br />Prapoacd Usu o1 �uiiding � <br />DoscripUon o( Work to Ge �one: <br />� <br />� Gi�y <br />i <br />: <br />us t� `t�i`� l <br />State�Zip <br />�ooi <br />�l zS- <br />8P-OG3� <br />Fhcne <br />State2ip � Phone II <br />� �_ , <br />��G�odi,Wr?- ��7-7�06 <br />. � / � StateR�p 9�p � Phonc <br />���6a �� <br />� CoriVact Prico of VJork � . <br />�/LUU= '�"'_ L�' — <br />Coniact Person (Plan Roview) � � � <br />:.�.1 Z�� (zC2. O� <br />C..l � S T.. � C06 « <br />' <br />NGl"E: WIRING IN NON-DWkLLINGS ISREQUIRED TO ; : �I . <br />BE IN RACEINAYS, MC OR AC CARLE. + ,, <br />� <br />CITY OP EVER[TT IOCAL SALES TAX CODE IS 3105 � ��� <br />1 herehy certily fhat 1 f�ave +�ad antl examined (his ap�licetion and knV�v fhe sr�mu to be lrua and <br />cr�trecL Af! provisians 0(laws and e�dinences qovoimng this t}�pe cl ��ork wdl Ge�.ompletecl <br />u•RC(l�or spen(e:1 heieio or noi. The oranting o/ � perm7t dces nol prtsume to.�ii'e nufhorriy to. <br />violate er cara�� Ihu provisions uf an}%other::tqte erlocal law regulating constn:c�on or fhe. <br />pede�mance ol c^•n�tructivn. That I am outhonzed by the o�vner althis property�� perform Uie <br />work Inr �Nnch appfisalion is made and I compl}� �vith the �tate Coni��ttors Law 78.27 RCW anA <br />'l9ti 200 INAG. ! �' <br />��t7,�._�� l ^ Z'� `� —� / - <br />FEE <br />LU1`'`�' i l�` <br />