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NOV-15-201z 22:52 From: To:2�78857 Pa9e:1�1 <br /> �w, <br /> � ELECTRICAL PERMIT APPLICATION <br /> . CITY OF EVERETT PERMIT SERVICES �► -/(, ..i�. <br /> .=�'� 3200 CEDAR S7REET, EVERETT, WA 987.01 ������ <br /> A25-257-8810 - FAX425-257-8857—www.everettwa.org <br /> •• APPLICA710NS ARE ACCEP7�D FROM S AM TO 4 PM <br /> �k��(0 � �lo"y �vQ � 2��� � <br /> PROJECT ADDRESS <br /> Cil SlateZp Phone <br /> O�mer Mail Address . Y <br /> ��o .� � ` �1,1 �3 <br /> Tenant <br /> Mall Address Clly S�tel7.ip Phone <br /> on�ro �;� aa� � f-�,� �'z.�c��i� �i�2o� �a�.�-�6.� <br /> Eleclric0l ConiraCtor Mail Address Gly 51a1e/2�C PhOne <br /> o�rrP ��'��D� �� , �� <br /> Sla��icenso Number Contract Pnce ol Work <br /> �� � �la�person (PIa�Y� <br /> Praposed Use of 8uilding <br /> Ocscriplion of Work to Be Done: � �� I <� """�' � — <br /> � � <br /> '(�Y�.�a I �. iG � ✓ <br /> NOTE: WIRING IN NON-DWEI.LINGS IS REQUIRED 70 FEE ` <br /> BE IN RACEWAYS, MC ORAC CABLE, ���� <br /> CITY OF EVERE7T IOCAL SALES TAX COD8I3�105 , <br /> 1 hereby ccrtily lhaf 1 havo reed ontl oxominod this app/ication�^e ol woik�will be complefed a�d � I /` � ^ ' �� <br /> corrccL All provisions oNaw�nnd ordinnncos 4ovominq Ihis typ <br /> nfieiher specifiod herein or nol. The granting o!a permrt doCs nof resuma fo give aufhoriry ro <br /> vrola(o or canCCl lhe prorisions OI any othersfale cr local law reguPting construction orfho <br /> peRormanCo of consfrucfion. Thef f am au!liorizeJ by fbe owner of this properfy fo pedorm the <br /> work lor which appliCntion Is mada t�nd/compty wdh Ihe 5lafo Contraclors Law 1B.27 RCiv nnd <br /> 296.2 WAC. �`�� .. <br /> I I � ,��7/�_ <br /> ignature � (��U V'� ' <br /> P�� c� ��' �� ) - asy� �e� � � , <br /> _ -- <br /> �----_ . .___ .__ _ .__ ._ . _ _ _ ----.. ____ __.___ _ .______ - -_..__-- <br />