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Oct. 18. 2011 10:50AM No. 1164 P. 2 <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 /> 2`T 3o Pa�av i�,�,� 81v d _ <br /> PROJECT ADDRESS /�25' 3$ 7'^��� <br /> _T <br /> Sh xru n ,M.�sr,►n 213� Pav►avie�W gl�d Evere�l��JA q820 I 'T <br /> Own9r MailAddross City St81e/Zip Phona <br /> �� <br /> Tenant MailAddf055 Cily SUlelZip Phone <br /> C(n 1-�ea�ind ��C. I�1� groac�wn_u �l �e'�' WA �1S?A 1 425259�O6�C <br /> E�ectrical Controctor Mail Addrese city SlelelLv Phone <br /> C�YII-4�1��l 4q 0 I G�t �O a(�8 . I 3 <br /> Slete License Number Contract Price of Work <br /> Proposed Use of Buiitlinp Contact Perdon (Plen Review) <br /> Description of Work to Be Qona. 1 �U n Gas � n e � 2 r/�'"-�S ' L�5 '_"� ( <br /> 2 aas ihSer'1'S Ru � �oou�2r -1-a 2 ireolc��.S <br /> N07E: WIRING IN NON-DWELLINGS IS REQUIREDTO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3106 <br /> I here6y certi/y thet I heva read end examined fhls application and know(he samo to 6e frua and <br /> CoaeCf. AI!provisions oflews and ordinances governing this type o/work will be cromplefed <br /> wf�etfier spenfied herein or not. The r�ranting ol a permif does not prasume fo yive aufhorify to <br /> violate or cancel the p�ovisions ol any other stete or locel lew regulatinp constnicBon oi the <br /> pe�formancu ol consVuctiOn. Thaf I am aufhorized by the owner o/lhis property to parfo�m the � n_ oq a <br /> work/or which appliCstion is made and 1 comply with fhe State Confractors Law 18.27 RCW end <br /> 296.200 WAC. �' I I <br /> . a.u� O � � g • � � � <br /> Slgnalure Dale <br />