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I <br />1 <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 - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />1S1 R 1 12th St SE <br />PROJECT ADDRESS <br />Silver Lake Ventures INC <br />Owner Mad Address City Slatelzip Phone <br />76 Gas Station I S I S I I2th St SE Everett WA 9R208 <br />Tenant Mail Address City State2ip Phone <br />Insignia Sion Inc PO BOX 2849 Renton WA 98056 425-917-2109 <br />Electrical Contractor Mail Address City State/Zip Phone <br />INSICSIOSSIS SS00 00 <br />State License Number Contract Price of Work <br />76 Gas Station Steven Thomsen <br />Proposed Use of Building Contact Person (Plan Review) <br />Description of Work to Be Done: Hnnk R w Oasis 76 sipn ae to u1slinn ririn tits_ _ <br />NOTE: WIRING IN NON -DWELLINGS IS REQUIRED TG FEE <br />BE IN RACEWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 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 />whether specified hereln or not. The granting of a permd does not resume 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 roperry to perform the <br />work for which application is made and I comply with the State Contrectors Law 18.27 RCW and <br />296.200 WAC. <br />stemit �R(t111JC1/1 ent) 7/ 25 /07 <br />Signature Date <br />