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DEC-14-2009 12:41P FP0N:DAHL ELECTRIC-EVEPET 425-252-2999 T0:2578857 P. 1111 <br />i, <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />772o l t-h to ee� .S <br />PROJECT ADDRESS <br />Owner <br />r.lud Address <br />Cuy Stntc:Zlp <br />�` U&' 44 9 G20 3 <br />Phone <br />Tenant Mad Address <br />17�:� � Ec.�zne-�e 1�c.�.. 3�/0 9� °��•�C°utu�'1'Gl�,¢ <br />City Slaterzip <br />gym � <br />Phone <br />zsz <br />Electrical Contractor <br />Mall Address <br />City Slate/z p <br />Phone <br />Dgl�LEEI ?;?6 0 <br />State License Number <br />© tie e-' aoeeezT7evJ <br />Proposed Use of Building <br />Description of Work to Bo Done: <br />NOTE: WIRING I14 NON -DWELLINGS IS REQUIRED TO <br />BE IN RACFWAYS, MC OR AC CABLE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br />I hereby candy that t have read and examined this application and know the sent& to be tare and <br />'U. All provisions of laws and ordinances governing this typo of work will be completed <br />Thor specified herein or not. The granting of a pornut dons not pprosumo to givo authority tc <br />fo or cancel tho previsions of any other stnto or local law rogufafing construction or the <br />mnance of consfruction. The; I am authorized by the owner of this property to perform the <br />for lvl rh npplicatio . mado and I comply with the State Contractors Law 18.27 RCW ar <br />200 <br />$ 27300. �© _ <br />Contract Price of Work <br />Contact Person (Plan Review) <br />r-i]iiiiiiil <br />FE <br />aiz.so <br />