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P.O1 <br />Aug-03-11 10:27A <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 ca, 3-- \1 <br />425-257-8810 - FAX 425.257-8857 - www.everettwa.org /fo 0_0aU <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />�56 ! �'/" AV rS1E, <br />PROJECT ADDRESS <br />Owner Mail Address City Slate/Ilp Phone <br />Tonant Mail Address City � StaletZip Y 2 P Phono <br />Electrical Confraclor Mall Address city Slata2ip Phone <br />FC 4-XAJLrY IY2 LP /4 aCC) 0 <br />State License Number Contract Price of Work <br />Proposed Uso of Building Contact Person (Plan Review) <br />pn.Cvtilu� <br />Description of Work to Be Done: Mp' I �/Z /� lC•��L_ -__ <br />NOTE: WIRING IN NON -DWELLINGS IS REQUIRED TO FEE <br />BE IN RACEWAYS, MC OR AC CABLE, I �� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby codify that I have rend and exernmod this application and know the samo to be hvo and <br />correct. <br />All provisions of lnws and ordinances governing this type of %vork will be completed l l <br />Ivltetitor speclfiod heieln orttot. Thu granling of o permit does not� resume to give authority to <br />violato or cancol the p visions of any other state or local law reguleling construction orlhe <br />petformanco of cons! itctlorr. That I am outhotiied by the owner of thls propwty to petfonu fho <br />work for which appl' tion Is rnado and I comply With fho State Conflactors Law 18.27 RCW and <br />296.200 WAC. <br />Signature ---- <br />