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Aug 14 2012 Q�59F>.I-i ?o�ch [1FCVic Inc 4253778977 <br />pag= t <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVEREI?, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — w�n�w.everettwa.org <br />pPPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CF2EDIT CARDS ARE D10T ACCEPTED <br />�'� G� U N�N <br />PROJEC,T ADDRESS <br />E►-j-� z�IS ►5'" ST Ev���rT w� ,�i82o1 �fzs. ��3. I IZI <br />Ownor Mail Rdd�ess Ciry Stala/Zp Phone <br />Tenant <br />Mail Adtlresu <br />Ciry <br />State/Zip <br />Ptwne <br />g DScH E���«- PO 6UX l �S 3�-�`- S�"`���5, v�J/� � g 2S�Q �{ zs . 397- 876 S <br />EleCtrical Contractor Mail.wtlress Cir/ Slale2lp Phrne <br />B�sch��wa c�r <br />State License Number <br />MU.t�"R-�itMll.�f �E�li7LIJC� <br />Proposed U5e ot Buildin� <br />De3criptlon of Work to Be �ano: W I IZ�NC �.�.�G R�%i� <br />NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO <br />BE IN R4CEWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />� �� ���. � <br />Contrac! Price o( Work <br />Contact Person (Plan Review) <br />1 hereby cerB(y that I have read and ezami,�ed [his applicatlon and know fhe same to be wa an❑ <br />correct. AU provisions of faws and ordlnances governmg thls t} pe of work will 6e comp/eted <br />whether specified horeM ornot. The grenfing ofa parmd does not F�esuma fo give eu(hodty'e <br />vrolale orcancel tl�e prov/sions ofany olnerste(e orlecal law regulating consWcfion orfhe <br />pedocnance o( construc6on. That i am aufhorized by fhe owner of lhrs property to paAoRn the <br />worA� `or which applicatlon is made and I comply wifh the Stato Contractors Law 18.27 RCW snd <br />25d.200 WAC. -- <br />� <br />FEE <br />�7�Sa <br />C�Zo�-UCe Z <br />