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N�A4. 29. 2u12 1 : 03PV NETVEkSANi 1��. 1146 �. 2 <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 GEDAR STREET, EVERETT, !NA 98201 <br /> 425-257-8810 - FAX 425-257-8857—www.everettwa.org <br /> � —i3— /z <br /> ApPIICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> C- 1Z05�1�{�` <br /> .��o� R`" �,� �.,��E�z-� ,�a� as� , <br /> PROJECT ADDRESS <br /> Owner MailAdtlress City StatelZip Phone <br /> �l,�S��t �)�'� �1�;�.� �At"�z S� G��r�..e.-E� �} � ci��_ <br /> Tenant MailAddress Cily Sta[elLip Phone <br /> ��Q.,�1.•�; �nlnt�� ,.14`�'k\�voe�ws ' SW ,�E a�oti �I�Rqf�JS'� �i�,-�-14-'� <br /> IEladricalContractor MailAddress City Stele/Zip Phone <br /> N���l�li�,(S �� � �J,J�00 . 00 <br /> State License Number Gontract Price o(Work <br /> �����cc,c:� �cr `� S�-��, • b�-��_2G <br /> Proposed Use of Building Contact Person (Plan Review) <br /> AOQO �(�� <br /> Squara Footage(If residential new construction,remodel or addition) <br /> Description of Work to Be Done: �l��J`C�iLI_.ti'Tl0� G� `��e5 ���TE-t"t S <br /> t't7(Z l�� 1.1E�,.3 ��I�RNC.� <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 IS 3105 <br /> I heieAy certify lhot I havs read and examined ff�is application and know the same to be frue end �I'a QS_ �l��� <br /> conect Aq provisions ollsws and ordinances goveming fhis type of v�oAr wilf be,complefed �.�r <br /> �vhelher spec�fied herein oi not. The grenting of a pem+d does not resume fo give aulhnnty fn <br /> violale orcancel the provisions ol�ny ofherstale or/ocells�v reguPa6ng consUuction o�fhe <br /> pedom�anco of consWction. Thet I am authonzed by the owner of this property to pedorm tte <br /> work lor which eppGesnon is msds and!comply wifR Ihe Ste(e Controctors Law 18.27 RCW and <br /> zss.2oo wac. <br /> ' 5- - <br /> Slg r Date , <br /> � <br />