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Sep. 6. 2012 9 : 58AM No. 5105 P. 7 <br /> 411 • • <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 B AM TO 4 PM <br /> a5a 1 LOM baxc, Ev q $ 2-0 i <br /> PROJECT ADDRESS (3 4\ <br /> mINA 6 NV 1 \...,,y444,,T A3 trt,h sait." e___Izlp Phone <br /> Owner Mall Address City <br /> Tenant Mail Address City Stale/Zip Phone <br /> LI r <br /> A I1415 gr tdtak v 7x-. ., . .y 20� '2 25• tA6L0 <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> CA-N-AAM q QI Lci ° <br /> State License Number Contract Price of Work <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Description of Work to Be Done: I n 1C't C W �.�'v 1 <br /> 16 <br /> CCk, ESC .t <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE op <br /> BE IN RACEWAYS, MC OR AC CABLE. 50 <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certify that I have read and examined this application and know the same to be true and /� <br /> correct. All provisions of laws and ordinances governing this type of work will be completed - <br /> v <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 regulating construction or the <br /> performance of construction. That I am authorized by the owner of this property to perform the <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> Signature 6 Date <br />