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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERViCES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 � � � 5—/D <br /> 425-257-8810 - FAX 425-257-8857—www.everetlwa.org ���I/ ��a-� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> too2s i�a, nvc sr <br /> PROJECT ADDRESS <br /> Dc �tcmadi <br /> Ownef Mail Address City Statt2ip Phone <br /> TBnaM Mail Atldress City Stale/Zip Phone �I <br /> Prcferre.ilileclric 9226232ndSUc�tSW Edmonds INA,'JSOZO 2U6.499.6691 <br /> ElectriCalConlraC�Or MailAddress City Stateflip Phane <br /> I'It IS I'I:I'.1929PI. �Z�.���.Qp <br /> Stale License Number Coniract Price of Work <br /> Dental Clinic <br /> Proposed Use of Building Conlact Person (Plan Review) <br /> Description of work ta ee Done: Panel/Peeder, Power Deaices, LigltHttg, LV Conduits <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN R,4CEWAYS, MC OR AC CABLE. S k90.00 <br /> CITY OF EVERETT LOCAL SALES TAX COQE IS 3105 <br /> I he�eby ceRily fhat I have read and examined this applicalion and know the same to be true and <br /> crorrect. All prov�s�ons o/laws and ordinances govemmg this fype o/work will be completed <br /> whefherspeci(ed herein ornoL The granhng ol a permrt dces not presume to give authonty to _ �a.�� <br /> violafe or cancel fhe provisions ol any other state or local law regulating concrNchon or the /C /� <br /> peAormance ol constiuu ion. That I am aufhonzed by fhe owner o(fhis property to pedorm fhe <br /> work(or which applicatibh.�s made and I comply wilh the Stafe Confrac(ors Law 18.27 RCW and <br /> 296200 WAC. j �. <br /> �� ~ ' ' --_�_.,.., I 1.5.10 � <br />� j Signat Date � <br /> ( RMwnp faClrc <br /> �� <br />