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03/31/2012 10:43 FAX 4253533934 Evergreen Security V1002 <br /> • • <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> i52I LUrn,Ccs W- <br /> PROJECT ADDRESS C��' ` L — ,(.c, —R 'D-� <br /> "T/kt+ ' <br /> Owner Mall Address City State/Zip Phone <br /> Tenant mail Address City State/Zip Phone <br /> t-opii ge - <br /> Electr�ntractor �il Address City State/Zip Phone <br /> State License Number Contract Price of Work <br /> R.o. ds,A1.)(-Ictil Corn Krbr al 7 , ,ri <br /> Proposed Use of Building -- Contact Person (Plan Review) <br /> Description of Work to Be Done: C CCAA,! 9/ I c <br /> vCU' 611, ro n Vi Ca,(/1, - --Li - ' "' <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE r- C)C59 <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certify that/have read and examined this application and know the same to be true and E l to g- P i 8 <br /> correct. All provisions of laws and ordinances governing this type of work will be completed <br /> whether specified herein or not. The granting of a permit does not presume to give authority to <br /> violate or cancel the provisions of any other state or local law regulting construction or the <br /> performanc- • •nstruction. That lam authorized by the owner of this property to perform the <br /> work for ich a.plication is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.20. WAC. <br /> 111t% -1 �. <br /> Signature Dat <br />