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10/13/2011 THU 8:32 PAX 360 805 0-87 MZLNE CLL•CTRIC <br />ELECTRICAL PERMIi APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - vnvw.everettwa.org <br />APPLICA710NS ARE ACCEPTED FROM fi AM TO 4 P119 <br />0ooi/ooi <br />��'�o� N. �io�fw�.i . � 1.�� � <br />PROJECTADDRESS <br />a� � or.,,�,�, � ��. �r �� �= <br />� v�- � d�'�..,- s 1,�•�.�-f � c.�c-tf u�l- 9�ao 1 3$a - 4 a <br />Owner ��4ail Address City Slale2ip Phone <br />�"VCC (/n���t'X f-h4'�� ) <br />Tenant Nai� Aadress city <br />iyr3� i�,�~��r ST <br />�iy� , L �t,� �t.cGT s., � �. �' � ,a, o ,,.20 <br />Glectriral Contracter Mail Address Ci1y <br />/'L7/LN���//D/�N <br />State License Number <br />/t%✓�s ��j � iG��s c L.o o l� <br />Proposed Use oT'Building <br />Descriplion of Work to Be Done: <br />�' S +� � <br />� /'lir� GL. / n <br />NOTE: WIRING IN NON-DNlELLINGS IS 12GQUIRED TO <br />6E IN RACEWAI'S, �J�C OR AC CA13L�. <br />CITY OF [VERETT LOCAL SALES 7AX CODE IS 3105 <br />1 hereby certily thal I have road and examined ffris applicaliqn ard <br />Slale2ip <br />StatelZip <br />PhonC <br />0 <br />a�a �3 -5��� <br />Phone <br />N (�4 <br />Conlract Price of Work <br />G�lc,.lc Gh.sr..r <br />Conlact Person (Plan Reviee�) <br />e-^ � '(-� ...-f ✓ <br />3� a" �, � � <br />rv� fho same (o ho truo and <br />�oik aill bc ccmplofed <br />sumo !o givo authonty to <br />rq construclion or the <br />s propedy fo perform the <br />ctors Law 19.27 RCWand <br />/�� 3 � f <br />FEE <br />�'/�p .._ <br />I�� p - O�' <br />