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oaio�;zoio is: i� r•.�c a'L+i:113iA30 v:�k,uHi.i. H:i,i•:creic C�noz�ooa <br /> ELECTRICAL PERMIi' APPLICATION <br /> CITY OF EVERETT PERiVIIT SERVICES <br /> 3200 CEDAR STREET, EVCRETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-3857 — www.everethva.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> qqZ� 25�� � 72 i� L..b-�3 <br /> PROJECT ADDRESS <br /> n 3C� y��� 5�81 <br /> „� n f r c r �u „r ,—�Y ( n .��c-r (� L7 i�n x I 5 O 'F ��i r��/i�LE �/�� <br /> Chvilef Mall Address Clry StatofLip Phon� <br /> cA M F /1 S � f3�0�E <br /> Tenent Mail Address Ciry SlatefLlp Phonu <br /> '-f'L�- 3�5 - �7C�60 <br /> Varz,.l r-_ ��, EI_t�T 21 C. s ��_ �{�/S- S2 4 _ �.a Ke 5��-,JS Wr�. � 8zS b' <br /> E-lactrical Contraclor h�au ACtlress Clty St�te2�p P�one <br /> \/�q2,UEL��i98 M � � 4� 359 �o <br /> Stato Licenso Number Contract Pn of Work <br /> S : nc�G �'w ����.Y ��5 <br /> ?iopos Use of 8ullding Contacl Pcrson (Plan Reviow) <br /> Dosc�IpGon of WarV;to Bo Dono: �S 2E 2� � ��n �f� G-'T, z;n� GI_� �.a �y.�_�Y ��.S. <br /> /�G E�ti� C,on/c�� .ii[sj LD ti/ <br /> NOTE: WIRING IN NON•DWELLINGS IS REQUIRED TO FEE I <br /> BE IN RACEWAYS. MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALE9 TAl(COOE IS 3105 <br /> !horoby certity fhot I have read and examined thrs eppllcotlon ond know tho same !o be Wo end <br /> correct. All provis/ons ollews and ordinances govem/ng thls type ol worfr wilf be comoletod <br /> whefhar specified herein ornoL The prbnting o(o pormlt does notp resume ;o gfvo euthorrfy fo <br /> vlole(e or cancel fhe provlslons o(any other sfafo o:locol I�w rogulat/ng tonstrucUon or tha <br /> per/ormance ol consWdion. 1 em euthortred by tha ownor o/th/s property to peAorm !ho <br /> work lo�whrch appllcaflon Is m e nd I compiy with the Stete Contrac(ors Lew f8.27 RCN'any <br /> 296.200 WAC. <br /> J�t'� � ' /^ <br /> Ignature DaW � -Z lY <br /> � <br />