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• D � <br /> OCT 0 1 2012 <br /> ELECTRICAL PERMIT APPLICA�� WORK <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 `/ � <br /> 425-257-8810 - FAX 425-257-8857—www•everettwa.org �;y �3 <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �,-��tio'°y <br /> i2 �2� �R�� A� s. 5,..� io� <br /> PROJECT ADDRESS <br /> Owner Mail Ad�ress City <br /> Slale2ip Phone <br /> C�mb�� t�a� ��t,tl.�lins 127?.£s I���veS �y�� � �"�'� Statel�� 5o3-7�iP�-lo-31 <br /> Tenant Mail Address �'�Y <br /> �va�Sv� �cz�r�+v �rai� 8�sq S1nl �rruS I�' �aier�n D(� �rSC �3-�70-��3 <br /> Electrical Contractor <br /> Mail Address City State2ip Pnone <br /> � <br /> �Ron1SSG�b13�.�� �"�,� ��`I�8 <br /> State License Number Contract Price of Work <br /> �r'. 4�enr� <br /> �ce � �mrvw�c �� <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Square Footage Qf residential new construction,remodel or addition) <br /> Descriplion of Work tc Be Done: � nS'}?�y �LCSS C czL*'�r'�� � Yi r'+�et-� ���'"`^^ ' � dev��_ <br /> j�X- l>�T�o <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. �� OC7 <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 he.reby certily thaf I have�ead and examined fhis application and know the same!o be true and �I O _ ` �� � <br /> correcl. All provisions o/laws and ordinances�overmng this type o(work will be.completed �, � U <br /> whelher specilied herein or.noL 7he granhng ol a permrt does not presume to groe authonty to <br /> violate or cancel the proasions ol any olher state or local law regulating construchon or the <br /> perlormance o�consVuction. Thaf 1 am aulhonzed.by fhe owner of this property to perform the <br /> work lor which application is made and 1 comply wrth the S(ate Confracrors Law 18.27 RCW and <br /> 296.200 WAC. <br /> � ��e. �, ��/-���� � ;�� �7— <br /> - SignaWre Dat <br />