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RPR-19-2011 13:38 FROM:CBM HERTING 425-745-1344 <br />� <br />T0:14252576657 P:4�4 <br />l <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR S7REET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 pM <br />f�03'� Fl�emina Si- <br />PROJECT ADDRESS <br />Ownef <br />Elc�ctrical Contractor <br />%,-- (� 03`� <br />Mail Address <br />Mall Address <br />L 1 � <br />Mail Addrees <br />�f��P�M.�� 01 Q � <br />Stata ucense Number <br />Praposetl Use of Building <br />Deacrlption of Wofk to 8e Done: <br />NOTE: WIRING IN NON•DWELLINGS IS REQUIRED TO <br />8E IN RACEWAYS, MC OR AC CABLE. <br />CITY OF EVERETT i.oCAL SALES TAX CODE IS 3105 <br />! Irere6y certify that 1 have read and <br />corroct. AN provisions ot �aws and o <br />YJh9fi �er spccified herein or not. 7h� <br />violafe orcancoi U�e provi5i0ns o(d� <br />pvdormencvolconstmc!ion. Thstl <br />�rork !or which applicalion is made a <br />29G.200 WAC. <br />!"1 . f1 <br />Ciry <br />Ciry <br />ciy <br />and knovi the <br />YA6 oj work w <br />�� <br />p , , <br />StatelZip <br />State/Zip <br />state�z�p <br />�033.32- <br />Conhact Price of Work <br />Contact Person (Plan Review) <br />� <br />� ro be true and <br />completed <br />re authorrry to <br />tion or;he <br />o perfom� the <br />8.27 RCW and <br />FEE <br />� �� �'"1—�,��i <br />Phone <br />Phorm <br />Phone <br />