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08/30/2012 14:30 14257751960 ACTIVE ENGINEERING PAGE 01/01 <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX425.257-8857—www.everettwa.org �l(3 <br />APPLICATIONS ARE ACCEPTED FROM S AM TO 4 PM <br />aLio o ;11Si e �--►" <br />PROJECT ADDRESS <br />Owner <br />Tenant <br />Electrical <br />Mail Address <br />Mail Address <br />Mall Address <br />t-t (1Z' 1 V e -IF 0�5 6 M - <br />Stale License Number <br />O Vi�L� <br />Proposed Use of Building <br />Square Footage (If residential new construcucn, remodel or addition) <br />Description of Work to 8e Done: <br />NOTE: IN NON -DWELLINGS IS <br />REQUIRED TO <br />MC OR AC CABLE <br />. <br />FIE IN A <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3106 <br />a <br />City <br />City <br />E12og — <br />Statemp <br />StaleZP <br />State/lip <br />OU• � <br />Contract Price of Work <br />Phone <br />4 zs�y� 5443 <br />Phone <br />4a-')- 'jll! <br />Phone <br />Contact Person (Plan Review) <br />FEE <br />�v <br />I hereby caroly that I have read and examined this application and know fha same to be true and <br />cornet All provisions of laws erg ordinances poveming this type o/work w!ll bo completed <br />whetherspecifed heroin or not. Tha granting cue permit does not resume to gives avthorMy t0 <br />violate or cancel the pmvisions.of any other state or local law regufa ng�et� ro pneo! the <br />peAormancq of Dons rucf on. hef I am authonSed b Me ownerol t rs rRSNJn <br />the <br />wo <br />rk <br />liceli and I com ly with the State Contractors Law 1B.27 Cw and <br />a10 <br />