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10/27/2011 THU 14:07 FAX 425 988 6501-a_Sales _Copy <br />m002/002 <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 />PROJECT ADDRESS <br />Crl�lt,��ai( (jan,k-. oil e Itt(i,.! sf Hell, <br />Owner Mall Address <br />1y`.iV1 (/A- <br />statelzip <br />cam) ql I -1101I 1 <br />Phone <br />(,;It�r1�inC. t fLk- <br />►bID Lutac1{ nvc <br />c..,,ei-at <br />;vtl!%xi Clirs)303 Ibi <br />Tenant <br />Mail Address <br />City <br />Stalsop Phone <br />r)I1it( S-I( <br />3Cf.-'1 G Volt,( Rd <br />ok.,•I-- n <br />W1t11(4w- -I- <br />Electrical Contractor <br />Mail Address <br />City <br />Slate/Zip Phone <br />II.ILL-1 �V�'�'J131j <br />4 qw.) <br />State License Number <br />Contract Price of Work <br />12 can YYl 11 Iqlr <br />Contact Person (Plan Review) <br />Proposed Use of Building <br />Description of Work to Be Done: <br />0.�tL+I=tLYI <br />RJ Ln11 F-e "t'G hnyl A,- ti —ayl eQdYIE I• Cam. <br />NOTE: WIRING IN NON -DWELLINGS IS REQUIRED TO <br />BE IN RACEWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certifyY that ! have read and examined this apnplication and know the same to be true and <br />correct. All provislons of laws and ordinances gave rningA this type of work will ba completed <br />whether sneciffad herein or not. The oranfin9 of a peen t does not presume to give authority to <br />FEE <br />/I 10- - /Lov <br />