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01/13/2010 16 06 FAX 425 257 _67 EVERETT PERMIT SERVICES <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCE>TED FROM 8 AM TO 4 PM <br />PROJECT ADDRESS <br />ILI i031" V1 (vE C�vtuil1 -VejLs wl19W NV- <br />Owner Mail Address city Stat%zp Phone <br />]see 11 p'"AwA� Cl�uc t� 1 (b\Q_H- Qck�VeSS <br />Tenant Mai Address City Stalb2ip Phmv <br />153 Ll e <br />l 1 n _,A' ci p 1'1kCIr <br />Electrical ContractorCUOn` Mail Addracs city Stateop Phone <br />�r _11 <br />Mc1r u2cC- �IR<<L� <br />State License Number Contract Price of Work <br />Contact Person (Plan Review) <br />Proposetl Use o/8ulldinp _` 1 <br />Description of Work to Be Dora: <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 />I hereby, cedfry that I have read and eromined this application and know the sama to be, true, and <br />correct. Aft provisions o/ laws and ordinances goveming this type of work hie be complefed <br />whether spectfle herern or not. The granting of a perni does not prestlme fo give authority to <br />vtMppfe orcancel the provis ions of any other state or focal law rsgu tang construction or the <br />perTormance of consuctlon. That 1 am tfuthonzed by the ownsr of thlsyDroperty fo perform the <br />work Ica which appliceflon Is ma arid!comply %*l1 the Steto ConiractorS Law 18.2;' RCW 8nd <br />296. f)Q W C <br />r, qlulll <br />- <br />gnature Date n %I <br />N <br />