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JAN-08-2012 20:24 From: To:2578857 Paee:l�l <br /> l ` <br /> , ELECTRICAL PERMIT APPLICATION <br /> C�TY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT. WA 98201 <br /> 425•257-8810 - FAX 425-257-8857—www.everettwa.org <br /> APPLICA710NS ARE ACCEPTED FROM 8 AM TO 4 PM �� 9�» <br /> , �� 5 CrQ��rv�a� l�Jc�� 20 3 �,2�,, m �y <br /> PROJECT ADDRESS <br /> �wner Mail Address Ciy Statc2ip �'c Phone <br /> ��Q�'C� �mG ro.l11 .�s199a <br /> Tenant ��^ I Atltlresa city S18tClZip anona <br /> , <br /> �on�rol ��►c �?� i C�J��rr� �"i1P�P�f- �� �'�?01 `���36.�5 <br /> EIeCVic�l CoM�pC10r Mail Addrese City SlalolZfp Phone <br /> So�r� P ��'��D7 $ y,�85 <br /> S1alo Ucense Number Contmr.t Prir.n of Work <br /> (�r�,t�c a�ar�(;.l '(�.a�S ��`' <br /> Proposed se oi Buildin� Co tact Person (Plan Review) <br /> Dosc�ption of Work to Be Done: ,,,{ �t�� VQ I ,���x�3C,. <��� % 5�r•�f U� � <br /> �� cov��^a l , I n►.�v;c,e�s� <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3 JOS <br /> 1 hereby ceRiry thaf I have read and exar,�ined this appliceNon and know tHe same!o be(rue and �1 a O � —��G.{ <br /> coirecf. All provisions oi laws antl ordirances poveming fhls fype of work will be wm�/ete[1 <br /> whothor speclhetl hereln or not The�rpntin�ot a permif tices nof Presume to plve aufhonry to <br /> violafa or cancel tho provisions ot an:�other state or local law regulatiny consfrucbon or the <br /> peAormanee ol consinrction. Thst I um eutharized by the owncr of this property to perfo�m fhe <br /> wo�k lor which application is made and 1 comply wifh fhe Stafe Contractors Law 18.27 RCW and <br /> 29G.2 WAC� ��� • <br /> � "/ I / / �i <br /> � ignature atc F � <br /> ���- �� r.�Z.s- �-� � -a5y� . , <br /> _�,,��tr,.�e.r�:.�� -���_ ---- -- <br />