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i'L/16/'t013 05:31 PAX � QJ001 <br /> � � <br /> ELEGT�ICAL P�RMIT APPLIGATION <br /> CITY OF �VERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-88b7—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM , � —'b �3 <br /> C �3 �2 --�i� <br /> �ZO� <br /> �=-�-.�_ l5-!-r� S-�-re e, � <br /> PROJECT ADDRESS <br /> C'lear (�iee% (����i`L-it'lC�,t��S 391�1 ��sl-h S� /VE YVlc� rt/svi /�' <br /> Owner R1all Address City SIaIc1Z�p Phone <br /> Va�t�1-� <br /> Tenant MallAtldmss Gry Stato/Zip P�one � <br /> Nt.J��-CV IitQl10E 1�1c:C_�+'%C_ -73�-% a��l1Cl {�/Il'Ll' �1�cti'!c�^<Y=c� �1�`����? <br /> EleclncdlCOnUddO� IdallAddress Ciry Stale(Llp Phone <br /> Pc:=2�c[.i�i�i C�' 3 c,�o. oc_, <br /> State License Number Contract Pnce of Work <br /> Lomrneti�ci�t � <br /> Proposed Use of Bmlding Contact Person (Plan Review) <br /> Dnseriplion of Work to Uc Done. _ _� __ __ <br /> !�/C�I,C� ��:C. �9�1�� ��"���LQ:7�_ :JU7�l�/� `L <br /> NOTE: WIRING IN NON-DWELLINGS IS R[QUIRED TO FEE � <br /> BE IN RACEWAYS, MC OR AC CAOLE. I ���� <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 3'106 --- <br /> I horeby cortily thaf 1 ba vo ror�d ond oxominnd fhis application and know Iho same to bo fiuo and j— ��1 � , Oa I <br /> canncL A�l�iovis�ons ol/ows nnU oidmances goveming lhis type ol wortc will be camp(efed � � � <br /> wl�cthoi SpocAiotl horv�n pi nof. ihu gnnfing o/a pormit doos nof resume!o yrvo uuUionty fo <br /> v�olafa or cancM Ihe prov�sions ol any o�hor stato or�ocul law roguPa6ny cons�ruc�i:�n w�ho <br /> podormenco ol consfnicfion, Thaf I am oulhorired by fho owncr o/(his proporiy fo puA�nn tho <br /> wort�/or which appliculion Is mode ond I comply wdh fho Sfo(o Conlrar.lor.s La:v 1�.27 RCW nnd <br /> 296.200 WAC <br /> �e,��JLE' �r�1�"�I�G7Yl (<� —1 LC/ -l� <br /> Sipnaluro Date <br />