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APR-29-2011 12:15 FROM:C&M HERTING 425-745-13�4 <br />T0:14252578857 P:4�4 <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EV�RETT PERMIT SERVIC�S <br />320D CEDAR STREET, EVERETT, WA 93201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />,�+-I-10 Y�J M�K�l�1-eo �31�d <br />PROJECT ADDFESS <br />�{ �-�q `' �� <br />G--IIO �f �-I ��O <br />Adam Bc?rKe 3�{-10 W I�luk�1 �$l��► �e,r�.if' WA-48�o3 425 R23 519R <br />pwncr Mall Address City Stete/Zfp Pnone <br />Tenanl <br />ElecMcal <br />Nall Address <br />Ma�l Aadrecs <br />C�i11 �-4'�i�l��i Q Ot�R <br />State Llcense Number <br />Propo3ed Use ot Building <br />De9cHptlon of Work to 8e Done: <br />NO7E; WIRING IN NON-DWELLINGS IS REQUIRED TO <br />BE IN RACEWAYS, MC OR AC CA6LE. <br />CITY OF EVERETT LOCAI, SALES TAX CODE IS 1105 <br />City <br />City <br />SlalefLip <br />3tatNZlp <br />5tc3io �i ca <br />ConVact Prlce of Work <br />Contact Person (Pian Review) <br />t Aoroby cortify lhat! hava read and examined thrs eppficetion and knowlho same to b@ trt+e and <br />corrocL Ar! provisions ollaH�s and ordlnances poveming thls type of work will be canpteteQ <br />whafher specified herein or not. The pranNng of a permR tloes not Aresume to yive auN�arrty to <br />vlolatc or conca! 1hc provisions of any ofher stete or loCa! law n°gulatinp consbvction or the <br />pprformonco ot ca�strt�cton. 77�at! am auMonzed by the owner ofihisp ropertylo perlo+m tlie <br />warVr for whlch appl;cafion is made end f comp7y wrth Mo State Contraclors Law f8.27 RCW and <br />286, 200 WAC. <br />FEE <br />Phone <br />Phone <br />i..�` 1 � - � 'l (O <br />