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11/O5/2�08 12:59 253-631-7754 PP.OVIDENT ELECTRIC PAGE 02/02 <br /> � <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVyCES <br /> 3200 CEDAR STREET, EVERETT, WA 982U1 <br /> 425-257-8810 - FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FRON18 AM TO 4 PM <br /> ! 0 3 I Ca(6�./ ,4ve. <br /> PROJECT A�DRESS <br /> Si-�flwecl iD3� �ih� A�� L1re�tl� VyA- �9�0� <br /> O�ner Mall Adtlress � Slale2ip �one <br /> �as- �r�-sa � <br /> Tenant MallAddmss Clly Stale/Zlp Phcne <br /> �o E3vx 5q,�s P� <br /> �v_o✓i�'e�t �(e�tvrc� l✓�� 2e��+v� , WA- °I QOar4 a53-�3l-7750 <br /> EIeCVicel Contractor Mail Adereae Clry SIat�2ip Phone <br /> P,�ovi�i ro3� � , 0�33a� �5vo, o0 <br /> State License Number ConVact Pnce ot Wo�k <br /> N�(.(� J h� <br /> Proposed Use of Duilding Contact Person (Pla�Revlewj <br /> Oesuiplion ol Work to 6e Done: �erlO 'Pl�'t P e�x�1,Vl,�c..� Q1ec(� i.i� GLn-cl� <br /> ��U.U.✓V1 �I�'�rk�Yl'1 ^ ��C �/1� S � . <br /> �� A� -l-c��-r.a�.c� ; �7oa �i.r�,��.e� : s�.� <br /> _' _"�" d <br /> NOTE: WIRING IN NON-DWELLINGS IS REaUIRED TO FEE <br /> �E IN RACEWAYS, MC OR AC CAOLE. <br /> CITY OP EV[RGTT LOCAL SALES TA%CaDE IS 3105 /��1 I .Q z� <br /> 1 horeby coY;ly(hat 1 have rend and examined this application and know tho same M be hue a.�d �� <br /> co,mcL All provislons oflaws and adinancas govoming this type o!�mrk�vlll6e completed <br /> aihoth,er speci5ed Hore;n ornot. 77ia granhnv of a pormd doos notprosume to grve euthordy fo <br /> vio!nte or eance/fhe piovisions ofany oflror sfato orloeal la�r rnoulafing construction orlhe <br /> peAom�onco of constructlon, That!am authoN:od by the owner of this propoRy to per`onr thd <br /> work for which applrcafion is matle and!compty wlth the Stafe Contrsc;ors Law 18.27 RCN�and <br /> 29 E.200 Y✓A C. <br /> �Q�� � C �/ NOV - 6 10D8 <br /> S�Qnaturc oele <br />