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11/16/2011 08:29 I�A\ (�J 001 <br /> � \ <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.evereriwa.org / <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM T04 PM « �6/�� <br /> Elll! �1 dl <br /> �5 a9 �S r"�a.a(u�a c�t_ <br /> PROJECT ADDRESS <br /> 1auWr�-ler5 15d�J E�roacl��ez �q ��yt'e•Lf:. U-3� yi':%_� 1 <br /> Owner Mall Addresn Gty Slete2ip Phone <br /> Tenant Moll/lddress Clly StalelZip Phone <br /> PeY`Fohn'1oY10E: EIEG'f'frG `730'1 ago?ncl P/ fIJW �_#arn,v��e:� Ggaqa �vo•5"�� 5'�1 <br /> Electrical Conuador Mall ACdross ciry Statazip Phone <br /> ��2��EtGi�ug � a3ao. oU <br /> State License Number Contract Price of Woric <br /> Fr^u..i�-- �:�c�•�cl <br /> Proposad Use of Building Cantact Person (Plan Review) <br /> Description ot Wor1c to Be Done: <br /> Re�la c i� I � �h-�- -Fi x"�L!✓Lf'� — r��17 �✓lE{r'c C.{ f�YG���YC�111 <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO �E <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3106 <br /> I hers6y ceAily fhaf 1 have read and examined fhis apP�icafion and know fho same to be hue end <br /> correct. All provlsions ollaws and ordinances govaminq Ih/s typa�work wi116a completed //,/a� <br /> whefharspeci5ed herein ornot. The granfiny ol a pertn�t does nof rasuma fo give authority fo � <br /> violafe or cancel fhe provisions ol any otherslete orlocallaw regu ating consfrucflon or fhe � �� <br /> perfortnance o/conslruction. Thaf I am aufhorizad by fhe ownerol fh15 Property fo paAorm the <br /> work lor which applicafion is matle and I comply with lhe Stafe Conhadors Lew 18.27 RCW and <br /> 296.200 WAC. <br /> n , � ��� . <br /> yC_i..�(��1(t 'c1�.:C•'t�?^� l� lG. ..i l <br /> Slgnalure Data <br />