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OCT-30-2012 19:02 Frorn: T.^.'�578557 Pa9e:1�1 <br />� <br />� �� <br />,�� <br />ELECTRICAL PERMiI" APPLlCAT�ON <br />.. �ITY OF EVERETT PERIVIIT SERVICES <br />._•^"�` 3200 CEDA,R STREET, EVERETT, WA 98201 <br />425�257-8810 - �AX 425-257-8857 — www.eve3rettwa.org <br />APP�ICATIONS ARE ACGEPTED FROM 8 AM TO 4 i'M <br />PROJECT ADDRESS <br />�� � <br />Owi�er Mait Address - City Stale/z�p � � Pttone <br />-� �J<l� 1 l /� <br />Tenani Mall Addr�ss �� ^ Ci1y r� Sra�e/Zip Phone <br />� <br />Electrical ContrdCtor Mail Address <br />�SC�➢U .� T P � �' �-� D � <br />St�te License Number <br />���.D��. _ <br />ProposQd Use of 6uiEding � <br />C}escription Of Work to Be Dono: <br />-�-- C� n�'� <br />NOTE: WIRING IN NON-DW�LLINGS IS R�QUIRED TO <br />BE kN RACEWAYS, MC OR AC CABL�. <br />CtTY OF EVERETT L.00AL SAIES TAX CODE I� 3105 <br />ll� W{� ! 0 7D� ��2 � �.�5 <br />City tateJZlp Phone <br />� �� <br />Contract Price ot Work <br />� ����- <br />Cantact Person (Plan Review} <br />s <br />FEE <br />��� <br />� <br />1 hsreby cerfify fh�t I have raad and examined this appllcatlon and know the sarne to be true and �(�r r� __ ��� <br />correct. AU prr�vis�ons of laws and ordinancos governrng this typa 4f work will be completed i l U <br />whefytar speafied hereln or not_ The granting of a permrt does nof presume to give aut�orlty to <br />violato or canG�! Il>e provisi0ns o( any other state or local law ��gulatir,g construction or the <br />perfvrmance of construction, That I am authorrzed by 1he owner of this property to nerfnrm fhe <br />work 1or wnlch applrcatinn Is made 8nd I comply with fhe S(ete Confractors Law 16.2� RCW and <br />�c�h �� waC. / <br />� �� <br />J <br />' �"Signature / <br />��� �c� '��� �� � <br />�.�y QQy�✓ ' .. <br />�.. <br />� <br />