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Fpr 09 06 09: 53a P• 1 <br /> � <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR S7REET, EVERET7, WA 98201 <br /> h25-257-8310 - FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DE817$ CREDIT CARDS ARE NOT ACCEPTED <br /> /d 33 ��.ax�< �v� — a �c <br /> PROJECT ADDRESS �� <br /> �3,�y <br /> �,�� rlT�PifT2/G/< /03.3 DAkk`J /4V ,���o/ <br /> Own2r � Mall Address Ciry SW�e21p Phone <br /> T6nant Mall Atldress Clty State2lp P�D�o <br /> Y�s <br /> ��'c.��up�� sas 3�a1 �u Ay �V 9��0/ .7s9 ���/ <br /> Elec:�cal Conlractor Mall ACOtess Clly Sta�o�7JP Phona <br /> �Y�,a a ss-i y� �i� <br /> State License Number Conlract Prica of Work <br /> SF2 <br /> Proposed Use of 2uildi�g Contact Person (Plan Review) <br /> Oescription of Work to Be Oone: /�F� a�0 �}/�!1'� ��N�� f �/1�(�•Q.JF � �OtJf'C <br /> 1�Lr�l.NS—�Sf�� �' �—f'L��,EG K ��N ��,��(� T6 [�,ET.FTcl�.f/� <br /> r'xA. n i� z � 3S°�' � F�� F'12o�� P/�l�'L �ldA ti Xllll.t�F�iE'A kN! <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> 8E IN RACEWAYS, MC OR AC CABLE. � �p <br /> � G <br /> CITY OF EVERE77 IOCAL SALES TAX COOE IS 5105 <br /> 1 here0y certily thnf 1 have read and examined this appllcetign and know the seme to be froe and <br /> :or�act. A�l provis/ons o/laws and ardrn�nces poveming fhrs type of work wifl be completed <br /> whe�herspecified herern or nof. 7ha granfing o!a pwmif does not presume fo giva authonty to <br /> vielate er cancel the provislons of eny ofher s�afe or loesl law regu/afing constrt�etlon or fhe <br /> poAormanco of const�ucfion. That!am avthonzEd by fhe oN�ner Of lhis properry ro pa�form the <br /> wak for wh�ch applicet/on is mode and 1 cOmply wlth the Sfota Contrncfors Law 4B.27 RCW and <br /> Z96.200 WAC. <br /> �/ l <br /> Slgnaturo o�� <br /> • <br /> i .E DCoO�{-0�(,8' <br />