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JUL-20-2011 WED 12;44 PM Prime Electric FAX N0, 4257475552 P, 02 <br />ELECT�rCAL pERMIT A�PLICATMON <br />CITY O�' EVERETT PERM�T SER\/IC�S <br />3200 C�pAR STREET, EV�R�TI', WA 9820� <br />425-257-881 d - FAX 425-257-8857 —www,everettwa.org <br />APPI�ICATIONS AR� ACC�PTED FROM 8 AM TO 4 PM <br />��e���`��������� ���� <br />� � <br />��! ,� , ����" � ��,��� <br />PROJ�CT ADDRESS � <br />���� <br />� ������ <br />OWnef Mail Addtos6 City 5 ate2ip Phono <br />1 r �� 1 � �� �/ <br />Tenant <br />Mail Addrees <br />�lsctrieaf Cantractor � � Mail Address " � r <br />. G �i�. y ���/ <br />State License N�mber � � � �, <br />'• — - <br />ropas <br />Description oF Work to Be pone: <br />NOTE� WIRING IN NON-DW�LLINGS IS REQUIRED TO <br />BE IN RACEWAYS, MC O�t AC GABLE . <br />City <br />State/21p <br />PhonB. <br />n�� <br />Cify StatelZip Phone <br />� �� DD �� <br />� Co�frac Pr' o Work � , <br />� <br />Conlact Person (Plan Review <br />j- C������'y`��-��� <br />��� �� �,r���' <br />CI7Y OF �VERETT L�CAL SALES TAX Cpp� IS 3705 <br />I hereby certify that 1 have road and examined fhis application and know the seme io be true and <br />correct. AlI provisions of laws and ordinances c�overrnng tl�rs typa of work will be completod <br />whethor s�ecrfled herefn ar not, The �ranting of a pe�md does not prBsume ro ���8 �urrtorrry ro <br />violafe or esncel the provislons of any ofher sfate or local law regulating construction or the <br />perftlrmanco of consUirction TI1�t I am authorized by tfle owner of thls plopel4y to perform tl7e <br />296.20a WAC applrcafion is rr�d�nd�mply w� the State Contractors Law 18, 27 RCW and <br />Signatur� �' - ' <br />�i�%/L��y�+/` !/� 1 <br />