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01/09/2009 13:50 4254�B5288 PAGE 01/01 <br />( /$�o �- l.L •� � Z� � <br />ELEGTRICAL PERMIT APPLICATION <br />CITY OF EVER�cTT P�£RMIT SERVICES <br />3200 CEDAR ST� EET, EVERETT, WA 99201 <br />425-257-8610 - FAX 426-257-6857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPT[p FROM S AM TO 4 PM �_ � z <br />�Jc�2 S'� ���-�T' U�'�-�� <br />PROJECTADpRESS <br />O�mor <br />Tenant <br />Mall Adtlmss <br />Mall Address <br />City <br />Cily <br />Stale2ip <br />C O q C 1—CZ3� <br />Phone <br />SlatefZip � Phona <br />?• S�i <br />�'}�i�l�GGC7Z1't*�1 �jp;J�C.t� i��zy�:. c�wp<wy��tiar P:17It'YL lL��}" �CiL'/� ;Si��'-I�Gi� <br />Elecirical Contractori Mail Adems.a Clty StateTp Phone <br />_A��i 5�yl.��zv5 <br />State Llcense Numher <br />Propased Use of Building <br />DesCription of Work to Be �one; <br />l 9ao• � <br />Conirad Price a( Work <br />r��� ��x �}3.�}�-„u.� <br />Contact Person (Plan Review) <br />j � 1.lrc �i-f 1� �� • <br />NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO <br />BE IN RACEWAYS, MC OR AC CABLE. <br />CIiY OI� [VERETI' LOCAL SALES TA% CODE IS 3105 <br />1 hereby certify thaf I have reed and exemfned fhis app/icafion end <br />correct. Al/ provisions of laws and ordinances govem/ng fh/s fype <br />whefher spec�fied hemin ornvt The g2nfing of a pennd does not <br />violato orcancel !he provisions of any oUror state or locol /aw regu <br />portormance o7consWc6on. That 1 am aulhorizod byfhe ownaro <br />v.rork for �vhrch epPAcallon is mado and I compty with lho Sfato Coi <br />29G200 WAC, <br />FEE � <br />end �6 � b ( — �� 1 <br />to <br />