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06/11 '2012 15: '22 FAX 4259157830 1'ARNIA.l. I.LECTRIC 0002/002 <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 ACCEPTED FROM S AM TO 4 PM <br /> PROJECT ADDRESS <br /> Z/ZC- ri70 6767 <br /> Py("_V. .a 5 fuy r —it rS 10AI 1301-) /1rfMQy5VrL6 �IA4 IgZ70 <br /> Owner -Mall AddrOss Cly Statemp Phone <br /> Tenant Mall Addrass Cly State/Zip Phone <br /> Woo <br /> Gi1•rrresL r 1.401 C- <rZ_ R 7— LAii ci'gz! 53 <br /> Electrical Contractor Mall Address Gy State/Zip Phone <br /> \/ 11-0�!/ari.n/FET-�s7(�M � R51S <br /> Stale License Number Contract Prica of Work <br /> �vr t_o-r <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Descrlptlor of Work to Fie Done: W r 2� Or DI 10 1 f-)-< <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. I 2_0 <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certify that I have read and examined this application and know the same to be true and I 2,0 �/ <br /> Co roti. All provisions of laws and oidinancos govomin this typo of work will be completed <br /> whether specified herein or not. The granting of a perm t does not Presume to give authority to <br /> violate or cancel the provisions of any other state or local law regulating construction or the <br /> performance of construction. Thet i ern eufhodzed by the owner of this property to perform the <br /> work for which application Is mode and I comply with the Stale Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> Signature ate / �� <br />