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21-AUG-2012 23:14 From:6191234567 _ Paee:l�l <br /> . c � <br /> � <br /> � <br /> � <br /> ' ELECTRICAL PERMI7 APPLICATION <br /> � CITY OF EVERETT PERMI7 SEHVICES <br /> � 3200 CEDAR STREET, EVERETT, WA 98201 g `—'a.3 —rZ <br /> � 425-257-8810 - FAX 425-257-8857—www.everettwa.org <br /> ' C--►�B-�t� <br /> � <br /> ! APPLICATIONS ARE ACCEPTED FROM 8 AM 70 4 PM <br /> I <br /> � <br /> � -- Lvc w <br /> PROJECT ADDRESS <br /> ���14rc� � q�o /k ��n�h w4� Wb� y�.s �52 4�a9 <br /> Owner MaA Atl��ass y Slate2p Phone <br /> I <br /> I <br /> Tenalt MailAddress C)ity $IAtF��f Phnnx <br /> Sd'lL� ��-�u� �O e� l�t /V soc.to Sar C�r►rc�,,1-� C/1" �r'1(o7 <br /> E�ectrical Gontractor —Tda�oss C' StatoRlF R y q 3�Pho�o' 7Q <br /> 1 <br /> ,�i 6D�5Le g q a 6R y o a � <br /> Sta I faernse Number CoMract Price ot Work � <br /> � �� ` � !Je � � � Nn�e,� �i <br /> Propdsed U.. 01 Building Contact Person (Plan Review) <br /> i <br /> Squale Faolago(II resldentiel�ew construclion,remodel or addiEon) <br /> Descliption of Wark to B2 DOnE: �I 4 - - ��� I 1 G.�1 �j / v1� l��N��(Y.�� <br /> I <br /> NOTI: WIRING IN NON•DWELLINGS IS REQUIFED 70 FEE <br /> BE IN R,4CEWAYS, MC OR AC CABLE. <br /> CITY OF EVEHETT LOCAL SALES TAX CODE IS 3105 � ' <br /> f hereby coRi/y fhol I have�exd end examrned th15 application aod know th6 same to be fnle 8nd 7 �� � <br /> r:orreCf All provisions al laws artd ordinences goveming this type of work will be completed I <br /> whethcr specHied hereln or not The g�ariting o!3 permrt doas nofProsume to give authoriry to `— <br /> vJola[eoresneelfhe provisionsolanyothersteteorlocallawregulelingconsbuctionorthe <br /> peAormance of consUUetior. Thvt I am authorized by the owner o/fhis property to pcAor.n thC <br /> work for whr applfcnrion�s mado and I compty wBh the State Contrec(ors Law fB.27 AC W and <br /> 296.20o W <br /> �2- � �Ctl 2-- <br /> n re De!e <br /> I <br />