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12/09/2613 10:01 253-631-7?5a PROVIDcNT ELECTRIC PAGE O1/01 <br /> I <br /> ELECTRICA.L PERMIT APPLICATION <br /> ciTY OF EV�RETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, Wq 98201 <br /> 425•257•88f0 - FAX425-257-8857—www.everetN�a.org <br /> APPLICATIONS ARE ACCEPTEO FROM 8 AM TO 4 PM <br /> �iqo5 �s� {'L v.) <br /> PROJECT ADDRESS <br /> ��vG_ �r����(o�us PoISoxIN4ry r�'t�•ll Cru.lc G�ti�Sd�az �Izs-?_!o�_9c{fl <br /> Ovme Ma�i nderess � <br /> qry Statc�Zlp Phor�e <br /> Tenant Mall AGdress ��ry <br /> Slala/Lp P�one <br /> '�c3�r�A•�,i�<1.�.��� ,�. A an �.V1�980�{Z ZSS-C�3t-77 <br /> �.a�7_a�7 c',avtnaE <br /> Electricat ContraCtor Mail Aydrasc <br /> �n' Slale2�p P�orre <br /> �6aVSESi�-SG7_ <br /> Siale License Number <br /> Contracl Pnce of Work <br /> Proposetl Uso of Building Contaq Person (Plan Rev�ow) <br /> Cescription ot Work to Be Oone� Q-(T-{�"' ��{�,(,� ��yti <br /> l�N��� <br /> NOT[ WIRING IN NON-DWELLIN�S IS REQUIRED TO FEE <br /> DE IN RACEWAYS. MC OR AC CABLE. � <br /> CITV OF EVERETT LOCqL SALES TAX COD[IS�705 �O ,� <br /> I hereGy coiiity thaU have mad and exammod 7his application and knux thn some to ba hue and <br /> correc.. riU prorisions o�/aws and orJinancas govemmg(�i5 fypC o/a�orM tvil!be Complated <br /> �rhefher spoc�fied horein or not. Tho granting o!a permd does notp rosumo 7o give aufhonty to <br /> vrolate or r.ance!fhe provisrons o/any other sfoM or Pocel!aw regulaLnp cons6Uc�on or R7C <br /> tvcrk�r�inh ch appl celiCon�S mado and�l cnmply with fhB 31a(o Con�rnclors Law 78 27 RCW and <br /> 296 200 WAG. <br /> �l,�v��-�' �2�5 �3 �i3iz-��� <br /> ,gn ure �aIC <br /> � : ��� <br />