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05/05/2014 12:51 253-631-7754 PR�VIDENT EIECTRIC PAGE 03/03 <br /> . <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425•257-8857—www.everettwa org <br /> APpLICATIONS ARE ACCEP7ED FROM 8 AM TO 4 PM <br /> �Pa"� IO"1'G � SE <br /> PROJECT AODRESS <br /> Camc��e� {�&sacly�F2� M�AI .I� c,� qBo82 �}2S �8�i�1 <br /> Owner Mali AAdreaa <br /> Clly $Iefe/ZiP PAone <br /> TBnanl Mall AEdresa CI <br /> b StatHZIP P�one <br /> ��'(I� �L�1C. ��DX`�o8� �ll�'}�, C,�A-�F�I�253-1o'�I-1�5o <br /> ElectnC01 ConlfOctOl Mall AOdrasa Sble2ip PYone <br /> �pV1���o3L'�2 <br /> State License Number Convact Pnce of Work <br /> Proposed Use af Bwlding Contect Pe o �n Revie� <br /> Desc�ption o1 Work to Be Done: y_4� ��+�/1"►�' �T(� J�1 � � S 3 <br /> NOTE' WIRING IN NON-DWELLINGS IS REQUIR[D TO FEE <br /> 8E IN RACEWAYS, MC OR AC CABLE I��� <br /> Clri OF EVERETT LOCAL SALE9 TAX CODE IS 7105 / <br /> 1 horo6y certt/y fhat/have �ead and axamined Mis BppliceGon and know tbe same!0 6e frue a�d 1 r <br /> conr.c�. All proviLons ol lews and ordinances govemrnq fhi5 type ol wprk will be mmpleted �(�O� � D 2 g <br /> whetAer spec�etl herein o�no( The�ranGng ol e permd does nof p�esume�o give avthorrry to <br /> wolote or cencel(he provisions of any olherstate orlocal lew regv/aling consfrucNon or fhe <br /> perlormance ol tonsbucfion. 77raf I em eufhonzed by tAe owner o/Mis properry to peAomr the <br /> work lor whicA epplicetion is made and I compty wifh fhe State Conhac(ors Law fA.17 RCWand <br /> 796.?00 WAC. <br /> �'1/lP�-Yl �� SI51�H <br /> -�Ignature Dele. <br />