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06/23/ZO10 WED 3: 32 rAX 4253551610 dutton canon �001/001 <br /> ELECTRiCAL PERMIT APPL1CATlON <br /> C1TY OF EUERETT PERMIT SERVICES <br /> 3200 CEDAR STR�ET, EVERE7T, WA 98203 ` <br /> 425 257-8810 `- FAX 425-257-8857 —wv✓w.everettwa.org , <br /> ' APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARpS ARE fVOT ACCEPTED` <br /> f .,���5 l/12�J.JfzOc�" �'C�n?�rJ�y 5'C��o CJ <br /> ; <br /> �o�i'o/ - Z7 r'`',�� S� �c./-�z��- w l��-�a � <br /> � PROJECT'ADDRESS `� <br /> ; ��/S^ C�A,��S /�E �.S`� <br /> ; �vC�2Grr S�G��c��_ �1�,S�'"� Y L��l�-��". /t /y7� 2c r [`{/ <br /> i .� (f /���/"<�1�� � �i N'!� ` � _ �. . . .. � �S�^r7 / 9�' <br /> Owner Mail Address City Stafe/Zip Phone <br /> � <br /> Tenant Mail Address City 'State/zip Ph.ona <br /> l�2,�-,. <br /> (/�� �G r� ' .z�{o����r��u 1��.�� � it!'�G�qs� GL� � g 3��-- c'�� <br /> : �IeCtriCsf C.ontl'actor:; Mai!Add�ess Ci State/Zip . Phone <br /> �v��� ��7��� <br /> State License;Number Gontrect;Price o€Work <br /> ��t/Cr4�D� /�'</�L- �Cy�/� <br /> Proposed Use of Building Contact Person {Plan`Review) <br /> 3 c <br /> Description of'Work to Be Done: ' � � V/� �J ���jF}���5 ; CU t�: <br /> � :¢�. <br /> ��LUILC S�; 7��� �'�r�. � 5� � ;� �rz,� . <br /> NOTE::, WIRING IN:NON-DWELLWGS iS REQiJfRED 7'O . FEE <br /> ' BE IN RACEWAYS, MC Oft AC CABLE:; <br /> CITY OF EVERETT LOCAL SALES TAX CqDE 1S 3�05 . <br /> I hereby certifj%fhat/have read and examrnEd this app/ication and know the same to be irue and <br /> correct: A/l provisions of/aws and ordinances governing fhis fype of work will be complefed. <br /> whether specrlied herein or not. 7'he granting:of a perm�f does not presume fo give authority to <br /> wolate or ca�ce!fhe provisions of any other state or loca!law':regulating construction or fhe <br /> perfQrmance of construction. That/am authorized by fhe owner of this property fo perform fhe <br /> work for which applicafion is made and l comply with the State Contractors L.aw 98.27 R.CW and <br /> 296.200 W C: <br /> �2�.�-� (� � 23 ._ �'(� -.�'� . <br /> Sig ure Date ���.,../�'_� <br /> /�'/ �� <br />