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0;/?9/2012 THU 13: 59 PA% 425 415 6158 m001/001 <br /> , � C(;�..� � � �Yl 1� �. ,� -��1 S <br /> � ( �CtNI �� �Jl �}-eG� I'�" '-�'� - 'I�� � <br /> � <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 � _ 'ag .�/'Z <br /> 425-257-8810 - FAXA25-257-8857 -www.everettwa.org �/�3_/s� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> I � '"—' �4-�-e <br /> ' ��aa ��i-I - - �� �l ��i-� �I�zb � <br /> PROJECT ADDRESS <br /> � c� u:�' <br /> �ov� G��4�c� � o t� - �e:�etl- ►�� �ti�-� 1 `� <br /> Owne� Mail Address Ciry Slale2ip Phone <br /> �� Sc�.��P Gt S r,�i��v'� <br /> Tenant MailAddress City StatelLp Phone <br /> 1��CI-�1 C Co'Yv�rnu,v��C'f�I-idV� S (' p bl�vt� �c�1� 0�� L R��c��-�I��lz� � . . <br /> Eleclrical Contrador Mail Address Ciry g���/ Sl����P� ��� / Phone . � <br /> �f ��i� ��'� �'I 1� 1--�`� � O � 2 S � <br /> d � S C� � <br /> State License Nurr�laer Contract Price of Work <br /> Proposed Use of Building <br /> Contact Person (Plan Review) � <br /> Descrip�ion of Work to Be Done: � �� i � ' � � � <br /> �l� , c1, C. - �� J�vi G�� i-1•. 5 <br /> NOTE: WIRING IN NON-DWEI_LINGS IS RE�UIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certrly(hat 1 have read and oxamined lhis application ond know U�e same to 6e true and � _ 'S��/ <br /> conact. �I!pravisions of laws and ordinances goveming this type ol work will Ge completed � S O <br /> whe(herspecifiod herein ornof. The�ranfing n(a pennit does not presume to give authonty to <br /> violo(o orcancel the�rovisions o/any othe�state orlocallav�reyulatinc�constniction or the <br /> prdormanco of consVucfion. Thal I am aulhonzed 6y tho owner o�this property to peAom�the <br /> wo�k tor which application is made and 1 comply with the Stata Contrac(ors Low 1827 RCW and <br /> 29G.200 WaC. <br /> , 3 2� I I �- <br /> Signa uro ate <br />