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08/11/2011 11:40 FAX Q 001 <br />1 <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257.8810 - FAX425-257-8857—www.everettwa.org d �d <br />APPLICATIONS ARE ACCEPTED FROM B AM Tr` 1 PM <br />I ga c) land Place 5 E <br />PROJECT ADDRESS <br />P,rr ZeL�Sao hand PIaC�P- 5� E�ere�� l vA 98ao3 <br />Owner I tall Address Coy stateizip Phone <br />Tenant Man Address Coy State/Zip Phone <br />Pe(- o'rmance Electric. -73co-ogand P/ LLJuJ 61 t tiv_wd W19 29Q'Q <br />Electrical Contractor Mao Address City State/Zip Phone <br />P�2FoEra��08 a5o•oo <br />State License Number Contract Price of Work <br />Re6 i dencia <br />Proposed Use of Building Contact Person (Plan Review) <br />Description of Work to Be Done: <br />I DD >4mP TenlDorart f 6eroice. <br />NOTE: WIRING IN NON -DWELLINGS IS REQUIRED TO FEE <br />BE IN RACEWAYS, MC OR AC CABLE. .J—D D <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br />I hereby certify that I hatre read and examined this application and know the some to be true and <br />correct. All provisions or laws and ordinances govemingg this type or work will be completed �Q <br />whether specified heroin or not. The granting ofa perm I does not presume to give authority to <br />violate or cancel the provisions of any other state dr local law regulating construction or the <br />pertorinonce oi,constmction. That I am authorized by the owner of this properly to perform the <br />work ror which application is made and I comply with the Stafe Contractors Law 10.27 RCW and <br />296.200 WAC. <br />,e�•-�L�c� 8-I I -1 I <br />Signature '.rate <br />