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11/13/2012 14:29 14257751960 <br /> ACTIVE ENGINEERING PAGE 01/01 <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—wwweverethvaorg <br /> APPLICATIONS ARE ACCPPTrn FROM 8 AM TO 4 PM <br /> L�—--_— <br /> PROJECTADDRESS <br /> Lha ^ ac oil :�Il Sig" pis w EvmA l Ip 58Lo3 SZr Teo 9zs5 <br /> Owner MSIIAddraes Clty Slateop Phone <br /> 6 Slate/ZIP Phone <br /> Tenant Mall Address city <br /> Sol LNAe 1.1� V nn�lMt� ln�fl 98D3(o NzS �`r <br /> Elecldcel ConVaacr Men Address city Slate/ZIP Phone <br /> AContract P cy of Work <br /> State License Number <br /> Proposed Use o Bullding Contact Pnrson (Plan Review) <br /> quare Footage(If residential new 001`191ructi0m,remodel or addition) <br /> Desodptlon of Work to Be Done: <br /> NOTE, WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS. MC OR AC CABLE. <br /> SO 00 <br /> cITY OP EVERETT LOCAL SALES TAX CODE IS 3106 <br /> 1 <br /> here Cenily that f haw road and drdmindd Ih/a applicefMrpn and k ow the ac"'aro b fn, end <br /> dorroefy All prowsrons of fawn end onrinenfes ppvemrnq lhla type p work wJll Da comp�efeC <br /> whether spdcrddd herein pr not. )The grant np oil a pa•md does hof/ r¢sume to piw euNonly to <br /> vrofife or nAn�l the proWiiona o any other atgra or local raw/agu e(rnp COnaflucrbn or fns <br /> pp�aeprlormenee PTI <br /> nrel wr. that l am aufW red py the owner 01 f is pro L (e g2q�lwtn fire <br /> 29�IOr w/hAJ7ch�ep�plkyAa�rlon is medd entll comply wrth the State Contractors LaW 7d. RGW antl <br /> 29 �D W GY-�V 1/1 3 I(2 <br />