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01/09/2012 16: 16 0000000000 PAGE 01/01 <br /> � �� II <br /> i <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERE77, WA 9820'1 <br /> 425-257-8810 - FAX 425-257-8857—www•everettwa.org <br /> qppLICA710N5 ARE ACCEPTED FROM S AM 70 4 PM � --9�--/� <br /> �/20/-0� <br /> L2� 1 C� SF. '��ex2a-�r ��� �l U <br /> PROJECT AUDRESS J <br /> c�ry Stete2lp Phone <br /> Owner Mail Address <br /> �,�a�r� 5�� �S� a�b�.,L� �zs_�s3-�2 <br /> Ci Stete2p Phone <br /> 7enant MaV Address ry <br /> ,_�.i— [^ � �oa 'f 3S 't��.� vJf� � m1'SfS�'� <br /> AYJ�,��� G S���P Phone <br /> ElectflGalConUaClor Mail�ddrass ��n' rJj��•- U2,�—$"� � <br /> R�3ST'CL���i2 12v contraa Pd` c�o wo�k <br /> Stale License Number <br /> � �r'�S <br /> �\� ContaGt Person (Plan RevieW) <br /> Proposetl Use of Building <br /> � �Z �ta � a�o� <br /> Desc,�iplion oi Work to Be Done: � , /�� <br /> � �K^tT C✓t"l11�� � � i�n�/1.�� n Ol I'�P ��']Zi'1 A-�� <br /> NOTE: WIRING IN NON-DWELLING515 REQUIREDTO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> C�TY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby certily that 1 heve read and exemined this application and know the same f0 be frue and � a � ' . ��� <br /> corroct. All p�oVisions o(lews and oMinanCBs governlny this type olwork wiN 6e completed ( <br /> wheffierspec�fled herein ornoG The granting o!o perm�t does notp resume to give authority lo <br /> violafe o�canc fhe provisions of sny other sfete oNocal law re8uleting�onstruCUon or the <br /> performence n5lnrcfion. That!am aufhorized by fhe oWner of thl5 property lo per(orm tha <br /> 296 2r40 WA�,a dCation matle and I cornply wifh 'Confractors Law 1 B.27 RCW and <br /> 1 �i ZoIZ <br /> �gnalure oa <br />