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( <br /> ELECTRICAL PERMIT APPLICATION <br /> I CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETf, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEP7"ED FROM 8 AM TO 1 PM •DEBIT R CREDIT CARDS ARE NOT ACCEPTED <br /> � <br /> 2 0 9 � G4 s I N o R-�� �ve-re.f�F ,�r�T 9�''��' <br /> PROJECT ADDRES3 <br /> �rlbC� <br /> �d13`.!�►�a Wemee-( y2S Do�l�-iu s /NQ iV �'cn �e W79- ��'� 266'-33/ <br /> Owner �� Mall qdE� Clry StatelCip Phons <br /> �O . T/�hl 1-�- 20q �.0 C'n (j'1tin t� �"uP,ra,f-� Ul1t �}�OZg ;'Z�14/ <br /> Tenan Mall Addreaa Clty State2lp Phona <br /> I�a �' 1�'C �: a �re.-1„r c(��.� 2�'� Ave k� Ly�,v, we,��/ `Pd'ozfi ��j9/ <br /> IecUical onlractor MallAddrese Clry StatnZp Phons <br /> �Ac� r- 5� 96s ctic �o � <br /> Ste e License Number Contract Price of Work <br /> Proposed Use af Building Contact Pereon (Plan Review) <br /> Descriptlon of Work W Be Done: 7tJ [N S��/� q 3 D�� X l U � CA�,����n.� <br /> I � / !' <br /> �'V� 't4�f � �'sv"t°!� �� D Y . LM �e�l�a����, �(� T W l� tL� �X R!') <br /> �—` <br /> NOTE: WIRING IN NON-DWELLINGS IS RE�UIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> � 5S� <br /> � <br /> CITY OF EVERETT LOCAL SALES TAX CODE 13 3105 <br /> I hereby certi/y that I heve raed end examined this applicet/on and know the same to be true and ��� <br /> correct. All provis�ons ol laws and ordinances goveming thls type ol work will be completed <br /> whether speafied herem or not. The granhng o!a permif does nofp resume to give euthorrty fo <br /> violata or cancel the provisions ol any other state or local law regulaNng const�uctfon or fhe <br /> peAormance ol construchon. Thaf 1 am authonzed by fhe ownar ol this property to pedorm fhe <br /> work lor which application is made and I comply with the Stete Confracfors Law 18.27 RCW end <br /> 296.200 WA C. <br /> , l. _ _ �a - � q� b,3� <br /> , _---_ _ <br /> SignaWre Date v/ <br /> V <br />