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Jun.23. 2004 8:14AM Light Doctor <br />No. 4512 P. 2 <br />ELECVZICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 08201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />2 Sod, A <br />PROJECT ADDRESS <br />same Q� "bye, <br />Owner Mail Address City S,lalelzIP Phone <br />Tenant`_ MaiillAddress City Sla�ler�Lip �(j. L�/Phoon1e <br />2�-lot, l0�0-k Ave_ iAJ- �l�L=ram- ��LqB <br />ElectrioAlContractor Mail Address City Stalelzip Phone <br />2p Li 3 , ram. <br />State License Numbar Contract Price of IVork <br />jj!1!�— e <br />Proposed Use of Building Contact Pcrson (Plan Review) <br />f <br />Description of Work to Be Done: �— <br />NOTE: WIRING IN NON -DWELLINGS IS REQUIRED TO FEE <br />BE IN RACEWAYS, MC OR AC CABLE. <br />113.�1� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 - r <br />I herehy cenily that l hove read and examined this application and know the same to be true and { <br />correct. All provisions of laws and ordinances governing this type or work will be completed G�Q <br />whether specitied herein or not. The granting of a permit does not presume to givo authonly to <br />violate or cancel the previsions of any other state orlocal law regulating construction or the <br />performance oI construction. That I am authorized by the ownor of fhis roperty to perform tho <br />work for which appllcallon is mado and I comply with the Stato Contractors Law 1H.27 RCW and <br />296.200 14'AC. <br />�J <br />23 Uni <br />Signature Dale <br />