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03/08/2011 14:39 14257751960 ACTIVE ENGIh�ERING PAGE 01/01 <br /> � ,. <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEpAR STREET, EVERETf, WA 98201 3 _o� , � � <br /> 425-257-8810 - FAX 425-257-8057—www.everettwa.org � <br /> E1103 - � <br /> APPLICATIONS ARE ACCfipTED FROM e AM 70 b PM <br /> .1o92g EJe�q�c�►, �.few S�;+t /� <br /> PROJECTADDRESS � <br /> pt�cP-e,l�rson 1oS29 Ev<�5�n W.., $�•J�,Q �uc+�# W(� 9&04 Yu' :s9 9�aa <br /> OWfl¢� Mail Add29s � <br /> Clty StatelLp Phone <br /> ^ �r n�. a• C u+�W � le E lr� 82oH �i�s'•ac5•53? <br /> Tenant Ma11AtlCress City Stetelzlp Phone <br /> Ne:..r,�.1.,.,�1 rkc.�•c Uaoczoo"'�c� S�.J l�nnwsod t�JA S�oa� 4zc�34.8nS <br /> Einc[nqi�onttaaor MailAeere9s Clry Shta2ip Phono <br /> f��Z; 1�og�n,s 8z$a. �y <br /> State License Num6er � Contraa Price oi Work <br /> ', ll��v r�.e. Sri►dsA eYa l+8 i o9fiN <br /> Propased Use of 8uilding Contaet Person (Plan Review) <br /> Description of Work to Be Done: �; � _�d <br /> NOTE: WIRING IN NON•DWELLINGS IS REQUIRED Tp �E <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> �24. 3S" <br /> CITY OF EVERETT LOCa�SALES TAX CODE IS 3106 <br /> I nereby certpy that 1 have 2ad and exemined tbis appllcafion and know fhe ssme fa ba true and <br /> correct A/l piovis�ons oflaws and orrlirtances govem;ng this type of wodc wil!be completetl G I;� _�j�� <br /> whethers,oeclf,etl harain ornot. 7rie granting ofa peim,t does not presume to plve eathonty�o V� <br /> viola(eorcencClthe AtpWslonsofanyofhars�9lewloca!lawregulaGngCpnSWctionorthe <br /> peAormence o/mnstruefion. Tha�1 am authonzed py fhe owner o/th�s propeRy lo peripmr the <br /> ivork Por whicb application is made and 1 cvmpry wilh lhe Sfete Contractors Law 18.27 RCW and <br /> 296.200 WqC. <br /> 4..w.. 3 �&��, <br /> Signaturc ate � <br />