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DEC-OB-2011 02:18 From: <br />To�2570657 Pase:l�l <br />ELECTRICAL PERMtT APPLICATION <br />; CITY OF EVERETT PERMIT SERVICES <br />�' 3200 CEDAR STREET, EVERETT, WA 98201 1 a-fa` �� <br />425-257•8810 - FAX 425-251-8857 - www•everettwa.org C� f/ Z,{�2 <br />APPLICATIONS ARE ACCEPTED FROM !� AM 70 4 PM <br />�,8`f9 ���a�� <br />PROJEC7 ApDRESS <br />Owner <br />Electrical Conlraelor <br />Mail Addross <br />Mall <br />Mail Address <br />�r�z , P �9��'D7 <br />Stale Licensa Number , <br />�r ��nslti.� <br />Proposed Uso of Building <br />�escription of Wodc to Be Done: <br />NOTE: WIRING IN NON•DWELLINGS IS REQUIRE� TO <br />BE IN RACEWAYS, MC OR AC CABLE. <br />CI7Y OF EVERETT LOCA� 5ALES TAX CODE IS �105 <br />Cily <br />Clty <br />Ci1y <br />Statc2iD Phono � <br />�f2S• ZSZ-2ZZZ. <br />Sla�e/Z�n 1t Ph°^! <br />/`.r.rf.� -1 :;rP. 'i�_rC <br />Stale2lp Plione <br />� �jO�� <br />Contracl Pricc oi Work <br />� r, Shn�'� <br />Contacl Pcrson (Plan Revicw) <br />th21 I have resd end Cxamined this epplication and know the same fo ba lrue and <br />visrons o/ laws and ordinances goveming this type of work wiil he complEted <br />ced herein or not rho granting o/ a permlt dces not resume to grve au!noriry fo <br />�I !he provisions ol eny other stat8 or locaf lew repuPfing Const�ucfion �r fhe <br />' consfrucfion. TAat ! am authodzed by Ihe owner o(this propeAy (o pedorm fAe <br />applicat�on is mede and 1 comply wifh fhe Sfnte Co�trectors L[iw 18.27 RCW and <br />296.2 WAC. <br />� <br />Ipnature <br />QI�. c� <br />l�J ��in Ae <br />�z,s-�� � -a5y� <br />,n,�:�- cuuour�' �c <br />FEE � <br />l�O ✓ <br />r/ <br />�I �►2—D�eZ <br />