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04/13/2011 08:56 188B6159679 LIGHTS N PLASTICS PAGF 01/04 <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.everettwa.org <br /> APpLICATIONS ARE ACCEPTEO FROM S/U+1 TO 4 PM ' <br /> Uf 5 5�-c� Iv1�l Eur.�«�e p,� _)�„ �'�5 �,�re�-�- c.>l� °e�c+� <br /> PROJECT ADDRESS <br /> OWner Mall Address Clry � 3tato2lp pMne <br /> i1�U��� �I�� ivial F��h,��,,, WA„ w�.s �vereGl- wl} 99a0� N�5 -��9�YY <br /> Tanant Malt Ad as Gfy SlateZp Phrne <br /> M���t� ��c aaJ3 �5h���- s � ��� �z EFI� r�� q���y as3-3cy-55oS <br /> Elechical Contractor Mall Addrese Ciry Statel2ip Phona <br /> ��i RoL�.��ni a� � G�w. � ► <br /> SIa1e�icensn Number Contracl Pr1ce of Work <br /> CoY4lmrfc:it ' �Gi� Si.�nw�or�S <br /> Proposed Usc of Bullding Contact Person (Plan ReNew) <br /> I � 1 <br /> �escripllono(WorktoBeDono: ����N�N(�y�� hy �r�wrl` 1�lc: �e� � 1„�>yti/� ���af }�� � 1a5� <br /> i <br /> �L���-• V <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> � G, '� o U`� <br /> CIIY OF EVERE7T LOCAL SALES TAX CODE IS 3105 <br /> I hereby certlly thot I have read and oxamfned this appiicat/on end know tlie some ro be frue and <br /> cormcL All provisions ollaws ond orclinances goveming this type o(work wi116e completed �I � (��y-�%��� <br /> �vhetherspoclfied heroin or not. The gronting of a pormd does not prtrsume to giw authodty to <br /> vfole(eorcanco/the provlslonsofanyofhersteieorloca!lawrogulOfingconst/UctlOnorthe <br /> porfo�mance ofconstrvction. That I am authorized by fhe owner of this property to poAorrn fhe <br /> �rork lor which a pllcotion Is mnd and l compfy witb the Stato Confr�ctors Ww 18.27 RCW and <br /> 296.200�AC.i <br /> � y-l3 •l/ <br /> SlBnaturo Oata <br /> / <br />