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RUG-24-2012 10�29A FR011:DRHL ELG�TRIC-EUERET 425-252-2999 T0:4252578857 P. 1�1 <br /> ELECT�ICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES �_ a�t—�z <br /> 3200 CEDAR STREET, EVERETT, WA 98201 C� ao�_11� <br /> 425-257-8810 - FAX 425-257-8857 —www,everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> �� 3'D(� 60�nE��- F�•�=,��-rr Ni�t+ww� <br /> PROJECT ADDRESS <br /> EJ�ti=,firus AT Si�.v�,� ��Ku� 1�8Q1, ;;:,;,«, _�s,...r�r,- i.,a 9 ��psr <br /> Owne� Mall Address Clly Stale2ip Phone <br /> Tenant Mall Address Clry ^ Stale2lp Phono <br /> �1�l7 ' <br /> QA�a� rLEc-ttiPtc, �y�i Mc�Oou��t�� O�vF FV3i2c=Y'r Wl� `Igaol �s�-��ov <br /> Elecfdcal Contractor � MallAddro,e City Stale/Zip Phone <br /> ✓,�►9N�.��� 9�G Qt� �`30D �� <br /> Stato Ucense Number Contract Price of Work <br /> RSSl4� G0 Llvl�l�- <br /> Proposod Use o(BuIlding Conlect Person (Plan Revlew) <br /> DescriptlonofWorkloBoDono: ISCDNNFGT 0�-�'J "� I\�CD�(f�l.-Q /Y E �✓ <br /> ��u <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. G, � <br /> 5l <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> /heroby certlly thot 1 havo road end ex�mined thls appllcnflon and know Uie seme[0 6a fruo ond <br /> cormct. All provlslons o(laws ard ordlnonces governlnp thls typo ol work wlll be complofed � <br /> whether spocll/od hereln o�noL Tho granfMp of a pormrf doos nof prasumo fo glvo oufhadty to � 1 <br /> v(olafeorcancol0�o provlslonso(anyofhorsta(oorlocallawrepulefingcons(ructlonorlhe � �O ✓� � <br /> podormanco o/consiructlon. Thot 1 am aulhodzod by tho ownor o/fhls property lo pedorm the <br /> wak lor whlch Appllcaflon Is mado and I comply wlfh Iho Sfato Confrecfors Law 1(f.27 RCW end <br /> 296.200 WAC. ` ^ , <br /> // / <br /> 6`7`— �_ a � _ � �— <br /> /I A_ <br /> � � V�.�-._�� <br /> �'SlOnature Date <br />