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qPR-12-2010 01:26 From: To:2578857 Paee:i%2 <br /> � <br /> � ELECTRICAL PERMIT APPLICATION <br /> ; CITY OF �VERETT PERMIT SERVICES <br /> ,�' 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425•257-8810 - FAX 425-257-8857—www.everetlwa.org <br /> APPLICATfONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> •:. <br /> ��2 (o J��o��u �.�.� � /s'� <br /> PROJECTADDRESS �` <br /> Own!+r Mall Atltlress Clly S�afe/Ziv Phnne <br /> V�N�.��'�ks 1��� <br /> Tenant MaflAdAr9e6 Ciry SWM/Zip phooe <br /> �0�l��1"0� tC�G{�c � 1 G��L�6r'iL,t`t,��G'Q-�� ciB701 �a -� 3655 <br /> Eleclrical ConlraClpr Mail Ad�ress Cily � Slate2lp Phon� <br /> �i <br /> sor�r T P �c 9��D� �_ DO. <br /> Sta�e License Number Contract Pricr,of Work <br /> �c�� h7i�.4�' <br /> Proposed Use af Ouiidinc� Co lacl f'erson (Plan Roview) <br /> Descriplion o(Work to�e DOnC: �l,�J VQ I �� <�.�,�(� s��'�l <br /> e <br /> � co v�'1-r'a l � � . <br /> , iG S <br /> NOTE� WIRING IN NON•DWELLINGS IS REQUIRED TO FEE <br /> DE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OP EVCRETT LOCAL SALES 7AX COCE IS 3105 <br /> 1 hereuy cr.rlily lhat!have re3d and Cxan�inr.d this ef�p�icafion and know th0 Same fo be frus end � I �y—�/_ <br /> CcrrecL All prov�siun�o/le��f�s nnd or�linnnr,o5�oveimny(his lype ol work wdl be completeA �F� <br /> whether spenhed herem o�nol. The granting ol o pormd does nol presumn to pivo authorry to <br /> riolate ei canccl fnc+provislons ol�ny C�hei state er roca�law reyu/ating censtruCflOn Or tho <br /> perfonnancn o/constiucllon. Tha(!am aufhotlzed by the owner o1 this property to perlarrr Ihe <br /> worklor which appNcafion is ntatle nnd 1 comply wrth the StstC Contractors Law 18.27 RCW and <br /> 2962 lh'A C. <br /> iZl�� °�-- �—�Z—/U <br /> ign�twu WIO -.........-- <br /> ��� ���• 4 zs 9�7 ) -d5�� �y��e�' cy''�o�''�' , <br /> �j�N'/C <br />