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Jul. 13. 2015 9:4JAM Fidel Is No, 7605 P. 1 <br />� S <br />-„T <br />ELECTRICAL PERM�� /-\PPLICATION <br />CITY OF EVEI�ETT PERMIT S�i�VICES <br />3200 C�DAR STREET, EVERETT, WA 9820'i <br />425-257-8810 - FAX �425-257-8857 — www.everetfwa.gov <br />� V�t' (e.c_ r� I�/.tno r �-% 3Z. �ra� � ve.re�{-�-, w� �`� 20 ( <br />PROJE A[JpR�55 <br />Owner <br />Mall Adciress <br />�ve�q��.e.� ��nas Z.(nol SJmm�� �� <br />Terlant Mall Address • <br />[� f � � ( � 5 .5�0 � hG��1S'�'f'� .� i�' ��l <br />Electricaf Contractor Mall Adciress <br />�, aQ � �; �Z� � �.�. <br />State License Number (required) <br />D� � 5aa<� <br />Proposed Use of Buil�ing <br />�3 �� �� S`F <br />Square Foot ga (If residential new construction, remodel or addition) <br />�� � <br />Number of devices (If low vo(tage) <br />Cfly <br />Slato/Zlp Phone <br />f.���.k� W� ��� l yz.�- 2s��2`1��? <br />City Siale/Zfp Phone <br />Tuk.�'� � �� W� `ig � � zsr3'-G��3-t7�1 <br />Cily <br />Slale/Zlp Phone <br />0527�3 <br />City of �verett Business License Number (requlred) <br />�; ��,o� <br />Contract Price of Work <br />��,d�. Y�l����� ZS�3 �-!�S"�3 �l 70 � <br />Contact Person/Contac Number/Email <br />b��d... rn��erso��-�d.�l �s r,w, c.� <br />Description of Work to �a oons: �� f+� i n� (��� �0 1' ��YIV t� _�t� �o `�'b �% c� � � Cac.`)�n$ , <br />�r�S���G� nuv I"� ►ra�l�-- , <br />I <br />CITY OF EVERETT LOCAL SALES TAX CO�E IS 3106 <br />1 hereby cerfify ihaf l�have read and exsmined thls application and know the same tp be true and <br />correct. All provisrons oflaws and ordinances governinc� this lype ofWork will be comp/eted <br />whether speclfied hereln or not. The granfing of a permit does not presume to ylve aulhority to <br />vlolate orcancel the provisions ofany otherstate orlocsllawregulating constructron orthe <br />pertorn�ance of construcfion. 7hat I am. auEhorized by the o�vner of this property to port'orm the <br />work for which applicafion 1s made ar�d I comply with the Sfafe Contracfors Law 9827 RCW and <br />296-200 WAC. <br />%� /3���0/� <br />REVISED OdN620T 4 <br />F�� <br />.� <br />� c <br />p�RMIT# <br />E 15�7� U�71 <br />