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Od 17 2012 224FF7 �osch ElecVic [nc. 4253778977 <br />pac� 1 <br />ELECTRICpL PERIVIIT APPLICATiON <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FA)' 425-257-5857 — wvov,�.everethva.org <br />APPLICATiONS ARE ACCEPTED FROM 8 AM TO 4 PM - OEBIT 8 CREOIT CARDS ARE NOT ACCEPTEO <br />g0 � (� � Gu ST <br />PROJECT ADDRESS <br />Ovmer <br />Tenant <br />2?�� f S'-`` Sfi <br />Mail Aadrass <br />Mall AtforeSs <br />e ✓ e �{--i- W �i <br />Ciry <br />Ciry <br />�l,i.c�n� T.�c. PD �x f0$3 l_(c. <br />EleCtrical Contractor <br />Mall ACtlress <br />t�vs�!-t����3 Q T- <br />State Ucense Numher ` <br />`� P�cX <br />Praposoc+ Use of Building <br />�es�.ription nfWr.r� to Bo 7ona: �`� �_ f��_�� �Q(/LK. <br />Ci0/ <br />�8zD1 �{z�.3o3.r�2� <br />Stata2ip <br />Slale/<'ip <br />W� ag� <br />Sla1elZip <br />P�ane <br />Phona <br />�ls 3a� 8�6s <br />Fhone <br />�' S3o0. °�' <br />Contract Prico of Work <br />Contact Person (Plan Review) <br />VOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br />BE IN RACEWAYS, MC OR AC CABI.E. <br />:ITY OF EVERE iT LOCAL SALES TAX CO�E IS 3�05 <br />hereby certifyihar I have read and examined fhis app�iwtion and know the same !0 6e true and (� � 2� ��" � Z� <br />�orrecl. A!! pmvisions of la�vs and ordinances poveming fhis type ol work �w1J be c�mpleted <br />v,7efher soecibad horern or noL The grenfinp o1 a permtl does not oresume to g;ve aulhonty to <br />tio/a�e orcance/ tne provisions of any other stafe or loca/ law reguleting censtrvctioa orlhe <br />�eAormance of construcUon. 7'hat / am authonzed by fhe ownar o! fhis property to peAorm fhe <br />:rxN l�r which application Is made and I comply wifh the Stafe Contr'aclors Law'd.27 RCW and <br />96.200 WAC. <br />�� <br />