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ELECTRICAL PERMIT APPLICATION <br />CI'. '-` 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 ACCEPTED FROM 8 AM TO 4 PM <br />401P S6 Gyeref- Wlwt( IvV rye,,e7"f ,%/4 gd'2o$ <br />PROJECT ADDRESS <br />2ot,-Gse-�korf <br />wlJ k� F l,ertt- rya �ra� s a Evrierf rnall Iry >rUere tt { G✓A 96'aog <br />Owner Meil Address City State2ip Phone <br />0_A-r(!e4- L,.o U,4 a. 0--s L10(, Cvrre fF Palbll wd fz-�yeiV M W'4 99�B2a G6-e-7rfd� <br />Tenant Mail Address City State2ip Phone <br />_Odd -ri'.KP t /Pe4-ro'e Po b" S'457y 1--AsY4 Wit- 9y519-540-VS-4-93W <br />Electrical Contractor Mail Address City State2ip Phone <br />`rMe� glc3�� t'49-7 Ooo <br />State License Number Contract Price of Work <br />3pjs ,fie ss <br />Proposed Use of Building Contact Person (^Ien Review) <br />Description of Work to Be Done: -ea 4-r i t /r W ,` it /1 � O-� 14no Q c'✓ c ce c 1-5 <br />$ cnq( t?kcr.sr_ CL(A'k rtk AS IC t )'CWLo .t I eL e (i' ,) I +S <br />NOTE: WIRING IN NON -DWELLINGS IS REQUIRED TO FEE <br />BE IN RACEWAYS, MC OR AC CABLE. a S. ab <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />there certify that/ have read and examined this application and know the same to be true and <br />correct. All provisions of laws and ordinances governing this type of work will be completed <br />whether specified herein ornot. The granting of a permit does not presume to give authority to <br />violate or cancel the provisions of any other state orlocal law regulating construction or the <br />worrk for wh ch applicaticon is made and I authorized <br />by <br />the State ContractorspLawy18.27�RC W and <br />296.200 WAC. <br />signature, - veto <br />rc) 0 S- Cow <br />