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O1/13/2012 �'::I IFi:54 PAX 415 379 7045 VP,� Natural Cus (�j00'L/OOE <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,V1�'A 98201 ��Z <br /> 425-257-8810 - FAX 425-257-8857—wv�nv.everettwa.org I .- a 3V0� � <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM C I Zd <br /> �-�n 1���.,'t� I�v�. �v�t W;� 98zo3 <br /> PROJECT ADDRESS �5 ,�3_ �5.� <br /> � �p�� � � l � ��,f� tI1/ . -, 'I ��/ p <br /> a.�6l� �, L�'VN'� �1 IV Q.�` �L}LD K-��� �VC. �j1��/�X/�i VV 5� �02�� Pnone <br /> Owner , Mall Address City State/Zip <br /> Tenant Mail Address City � Slate2ip Phoae <br /> I� 2�-3'f�- l �l�i`f <br /> �a`��wwq�s+� }�c�u.ra� q� .l���r� c�a v�-o �.� (' �'�V � S�Zb� <br /> EleclriCal raduf � Mail Address Cliy SIa�e/Lp Phone <br /> �����c�qoo�P� � �,��3• 8� <br /> Stale Licenso Wnnber Contract Frice of Work <br /> �C°�l�lxl�1�� l�'� �� ��Y�I�l°.:8�1 I <br /> Proposed Use af Building Confact Person (Pian Review) <br /> DescriptlonotWorktoBe�one: ��1Qlt4�A4- � ld��n � ��""" ��� n��Q - <br /> NOTE:'WIRING IN NON-DWELLINGS IS REQUIRED TO FEE}, <br /> BE IN RACEWAYS, MC OR AC CABLE. r �r5 SU°� <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certify that!have read and examrnod fhis eppllcatron and know the same fo be(ruo and <br /> eorrecl. All provisions o(laws and ordinances governing this typo ol work wi116e complefed <br /> whetherspeci�ed heroln ornof. The granting of a parmif doos not rosume to give aufhoriry to <br /> violate or canco!the provlsions ol any othor state or locallaw�eguPting conslruclion or fhe L�`O r'O� � <br /> pedormanco o(consfruction. Thal I am au(horized Gy the owner o, fhis propeAy to pedorm fhe 7 <br /> �wrk lor which applicalion!s made and 1 comply wifh the State Conlractors Law 18.27 RCW end � <br /> 296200 WAC, ' <br /> , <br /> � / /3 �Z <br /> -- Sig atu o � <br /> L <br />