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SEP-29-2011 10t23 ELECTRI—CITY 425 672 6799 P.03i01 <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3201) CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO A PM <br />PROJECT ADDRESS <br />Owner <br />Mad Address ay StatelZip Phone <br />0/nC <br />Tenant Mail Address Ciitty,' State/Zip Phone <br />Electrical-- Contractor— Mailaadmss City StatelzpPhone <br />`fZ.S lv %z l0 <br />.F�cTr� �ro�A ��ood <br />Slate License Number Contract Price of Work <br />Proposed Use of Building Contact Person (Plan Review) <br />Description of Work to Be Done: <br />r � r <br />NOTE! WIRING IN NON -DWELLINGS IS REQUIRED TO FEE <br />BE IN RACEWAYS, MC OR AC CABLE, <br />CITY OF EVERETT LOCAL SALES TAX CODE 15 3105 <br />1 hereby certify that I have read and examined this application and know the same to be true and <br />correct. All provisions of laws and ordinances govemiq this type of work will be completer <br />whether specified herein or not. Thr granting of a permit does not presuma to give authority to <br />violate or cancel the previsions of any other state or local law regulating construction or tho <br />performance of construction. That I am authorized by the owner of this property to perform the <br />wok for which application is made and I comply with the State Contractors Law 18.27 RCW and <br />296,200 WAC. <br />Signature Date <br />TOTPL P.01 <br />