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O1/12/2008 12:31 4253538934 EVERGREEIJ SECURITY PAGE 03/03 <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-25%-8810 - �AX 425•257-8857—www,evereriwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> _ � � ( ( ��� �UE �� <br /> PROJECTnDDRESS — <br /> �t"�rr Mi a i nn�.�, ,��c. �oo l � 3r� A,rE � �v7- �-as- <br /> W� 3� 22Z( <br /> Own;r . Mali Atldress CiN Stale2ip Phona <br /> Tena��� 67ailAtldregs City Stat¢lZip Phone <br /> �-I�zS- 3 8 <br /> �Ve�ke.v� �r.u.P,r�( �I �s�2,�w��� r� (o� �� 2 3�Sa <br /> Eledncat nirador Mall AOdress Ciry Sta;u�Lip Chone <br /> �`��as-�t l�.L� 1 n, S�'q . Uv <br /> State LicNnse Number Contract Pnce of Work � <br /> �l lJ I STD{�a L f'PcGt U TL/ <br /> Proposed Use of Building ��— Contad Person (pian Revierv) I <br /> � Descnption ot Work to 6e Oono: _�_-�,� � � � � C�f ��� /� , , .^ _ ' ,_ <br /> �--v c,l.fi'P\J <br /> NOTE: WIRING IN NON-UWE�LINGS IS REQUIR[D TO FEE <br /> BE IN R�CEWAYS, MC OH AC CABLE, <br /> �:JCI. � <br /> CITY OF EVERETT LOCAL SAL[S TAX CODE IS 3105 <br /> �, I hervby certily thpl I have rend and axamined this application and know fhe same(o be frue and <br /> ivhether spePNfied herseu�oa nut�Tf e giant ng of a permit daesy ot/res qre fo give au honty to <br /> violate orcancellheprowsions ofanyofharsfafe orlocallnwregu�tinp constn,ction o�fhe <br /> Po�k lorwh chf��pnlcatloi�,s mndv�and I�mp�y edtblhe�State CorifmcforsPl wyj8.�RCWand <br /> 29 .YOD WqC. <br /> - � � � l 1 �o�' <br /> Si namre - �i� <br /> �OtC / �� � ,i_.✓ <br /> r� TV <br /> J U <br />