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10i01r2012 11:24 FAX 4253538934 Ecerereen Security <br />moot <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR S TREE T EVERElT, WA 98201 <br />425-257-8810 - FN(425-257-8857 — www.everettwa.org <br />APPL'CATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PROJECT ADDRESS <br />Owner Mail Aodress City slatelz'p Phone <br />-Rn�--yW-*"kkff- col P 4 Att: C-X�tocll q1 wl 47f25 33Ci-S, <br />Tenant Mad Address City stale/ZN Phone <br />( �rererr� +V1 211e) &'AA'4 V of GAIC -4 /if gsiw3 �3 3 <br />mucincal I`Contrador nU Addiess Vaty Stale.mp Pna,c <br />L'— eP- ,a 113( a *'lig - <br />State License Number:;r: 1: 1., Contract Price of Work <br />V_ <br />Pronnsed use of Building ( Contact Person (Plan Review) <br />1h:scnpllvn of Work to Be Done, Y� ".� <br />NOl"E: WIRING IN NON -DWELLINGS IS REQUIRED TO FEE <br />BE IN RACEWAYS, MC OR AC CABLE. h `� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cei ify that l have mad and examined this application and know tho same to be true and �� <br />correct. All provisions of laws and ordinances _onvernmg this type of work will be complolo0 L <br />whether specified homin or not. The granting of a permit does not ppresume to give authority to <br />violate or cancel the ppmvisions of arty other state orlocal law rngulatmg construction or the <br />Performance of construction. That I am authorized by the owner of this Property to perform the <br />work for which application is made and I comply with the State Confractws law 18.27 RCW and <br />29G.200 ld' 1 <br />ignauue <br />Stv Oatn <br />;_0 <br />