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06/09/2009 TUE 12:24 PAX 4253551610 dutton canon <br />Qj001/002 <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 8 AM TO 4 PM <br />Founders Bldg 2nd FL. 3901 FioytAvenue <br />PROJECT ADDRESS <br />The EveretL Clinic 3901 lloyt Avenue Everett WA/98201 (425)259-0966 <br />Owner Mail Address Cily SlalerLip Phone <br />Same as above <br />Tenant Mail Address City Stale/Zip Phone <br />Fax: (425 355-1610 <br />Dutton Electric Company 12407 Mukilteo Speedway, A-170 Lynnwood, 93087 (425)347- <br />Elechical Contractor Mail Address City Stale/Zip Phone <br />DUTTOEC137P3 $278.17 <br />Sate License Number Contract Price of Work <br />Medical Dave M. (425)359-4933 <br />Proposed Use of Building Contact Person (Plan Review) <br />Description of Work to Be Done. (1) Outlet & a Data for new wort: station — 1'-i 11e rta� <br />t <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 Ofr O�� <br />1 hereby certily that 1 have read and examined this application and Anow the same to be true and I�i 1 <br />correct All provisions of laws and ordinances governing this type of work will be completed <br />whether specified herein or not. The granting of a permit does not Presume to give authority to <br />violate or cancel the provisions of any other state orfocal fall, regulating constru,,:,on or the <br />performance of construction. That lam authorized by the owner of this ropeny to perform the <br />work for whuc application is made and I comply with the Slate Contractors Law it) 27 RCW and <br />296.200 WAC. <br />S Z <br />SiOnalSa'— — Dal <br />