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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERM(T S�RVICES <br />3200 CEUAR STREET, EVERETT, WA 9820 i <br />425-257-8810 - FAX 425-257-8857 — v�nvw.evereilwa.org <br />APPLICATlONS ARE ACCEPTED FROM 8.4M TO 4 PM <br />sSl�i! % �i%%/ /��/%C� s� <br />PROJECT ADDRESS <br />/�/�y/l:5 �"t�E ���7 yT�� <br />Owner M17ail Addross <br />$%%��li /Is f%i.��Di�f <br />Tenanl Mall Address <br />� C J �t/� /2 <br />[ledrical Conlraclor Maii AJdicss <br />Slate License Nwnber <br />'/ s . t_ �i'f�< <br />Cily <br />City <br />City <br />1 •�i��'n.'j S�✓/���' — <br />Proposed Use af Building <br />Description oi Work to Oo Done: GZ�'- �/1, i�•�� /� /%�- �/ i Q/+�/ <br />G�'A <br />State/Zip <br />Stale/Zip <br />StalclZip <br />CoNracl Price of Work <br />yZ5 <br />3ss-�393 <br />Phone <br />Conlacl Person (Plan Review) <br />Phone <br />Phone <br />NOT[: WIRING IN NON-eW[LLINGS IS REQUIRED TO FEE <br />BE IN RACEWAYS, �dC OR AC CAE3LE.. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby certiry that I havc n�ad and ezamineA fhis applia�fioa enU 5now the same fo be frue a��d <br />coirecf. All provisions o! la�rs and orilinances governiny fhis fype cl work will Le complefeJ <br />n�hether specilieA herein or not The pranfinp o! a pernuf do�s nct/�resume f� giee aidhonfy fo <br />��iolafe or cancel fhe ��rovisiens ol any ofher sfafe or loca( la�v re�u nfinp construc6on or fhe <br />perlorrnance o/ cons n�ction. That I am aufhorized b�� fhe o�sner o! tdis property lo perioroi the <br />work lor which applicativn is made m�d 1 compty n�ifh Ihe Sfafe Contractors l.aw 19.77 P.CIY and <br />296.200 N'AC. <br />✓ C � <br />�'--� ll. i �, �—� o.cc�— /CJ—J'l'% �/( <br />Sip 3turo oate C�� �i'�I <br />✓ <br />� <br />