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FEG9 :E�_�erqr�eri State Heet ° Rii FRX �JO. �425259665C� Rpr. 22 2011 Ol�16Ph1 P� <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.everettwaorg <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> l �� ! H�V�- A�� <br /> PROJECTADDRESS� <br /> L"�,+Qene KUrni I� lh�l �,�� �v�-H W� �lS�l -- <br /> O�m�r hlall AGdress Cdy Slato2ip Plw^ne <br /> Uwn�r �Z5-252�0188 <br /> Tanant Mall Addross Clry Sta�o/Zip Phone <br /> �V .�arccn Si�f� �h�r+� M�i� I 217o F�aci�ir �V� �N�'�i� W�I��Zoi �}�-z���� � <br /> Elecidcal ontrflctor R1ail Acldmcs clty State2ip rrwne <br /> ev�e�qs5 ��S r2n <br /> Stato Licens�mher Contr2et Pdce of Work <br /> �(�5i Ck-er�ce ��nd �I <br /> PropoSod Uso of Building Contact Peison (Plan Rxview) <br /> DescriptionafWorktoBeDona: ��F�IUC� e�� "�711nC1 �IIY✓I m�51(-l"I <br /> i <br /> NOTE: WIRING IN NON-DW[LLINGS IS RE�UIRED TO FEE <br /> RG W RAC[WAYS, MC OR AC CABLE. <br /> CITY OF[VHRC-TT LOCAL SALE9 TAX GODE 19 3105 <br /> 1 heioby certlfy fh[+(I havo roerl an0 oxaminod this al�A��cafion nnd know fhe sama fo be fru9 and � -� � <br /> caioct. All prc��imons o�laws and adnances govnm�ng 1F,is type o(work will bo completetl (_, I � �� � � r � �� <br /> whelher specHied hereln or nof. 7ho giantin�of o parnuf does not resume fo give aurhonty fo <br /> vlolofe or concel the�.rovlsions oleny othor stato or'focallE+wroguPt/ng tonsfrucfion or the <br /> pedermance o�construcGon. Th:3f I am authnr/zed by the o�mer o(this proporty to poAorm fhe <br /> ��.ark lor whlch npF���at�on is made antl t compry wlfh the Sfeto Co�itreclors Law 78.27 RCW and <br /> 296200 W�1C. • <br /> -�u� �"-22 -i� <br /> Slctn.vlure �ato <br />