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09/�1!2005 10:03 4253776977 BCSCN ELECTRIC INC PAGE 01/01 <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 58201 <br />425-257-8810 - FAX425-257-855; —www.everetlwa.org <br />R ` �-O5 <br />C��O��pO�f <br />APPLICATIONS ARE ACC�PTED �ROM 8 AM TO 4 PM - DEBIT & GREDIT CARDS ARE NOT ACCEPTE� <br />� a � ��u�S�-- <br />PROJECT ADDR�SS <br />C:►�A �'i15 15�= S� � L�er et-i- wt�F .`ioZL'I �-lis". 3&�. i l21 <br />Ownef Mail AGdre.e Cily Stafe/Zip Phone <br />7anant <br />��Su.� El.zct <br />Eloctncal Contrac�or <br />�,oscilEZ��3G�r- <br />Slate License Numbor <br />j..L�'�, <br />Proposcd Use of �uilding <br />Uescription of Work to Bo Donc: <br />Mail Address <br />Mail Qddress <br />City <br />Gty <br />:CC't'Y1C�t,� I.LPs�YYAtCi:� <br />NOTE: WIRING IN NON-DWELLINGS I5 REQUIRED TO <br />BE IN RACEWAYS, MC OR AC CAB�E. <br />CITY OP EVGRHTT LOCAL SAL[S TAX CODE IS 3105 <br />Steto/Zl� PfIC08 <br />w�A R82� �Zs"•'.fZ�- 87�cs <br />State/Zip Phone <br />Contrad Price of Work <br />Contact Person (Plan Roview) <br />I Y,ereby certiry that I ha�ve �ead and oxaminad this aoplica2iun and know tha sarne to 6e true and <br />correci. A�l provisions ���la�vs and o�Ulnances yoverning u��s rype cf �rerk w111 be comp/eted <br />whethur sp�alu3d han3r� o� net. The giantinq cf a permd does nct rdsume fo give authorrfy fo <br />vie�ate or cantel tne pmvisions o! any othur stato o� lecal law reguPating censtructien or ihe <br />portormanca o7 constru�fron. That ! am authonzed by the nwner of this properry to perlorm the <br />work tor �vhich applicairon is msve and I cemply w!!n ihe Sta[e Contrectors Law 7y.27 RGW and <br />�90200 WAC. <br />��'-�_�, <br />FEE <br />I <br />�1'�r'j - OOy <br />