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10l1812013 02:01 <br />#3393 P.001/001 <br />ELECTfdlCAL PERMIT APPLtCATtON <br />c�-rY oF �����rr QE�M�T �ERv[c�s <br />3200 C�DAR STREET, �V�R�'iT, WA 98209 <br />�25-257-8810 - FAX �25-257-$857 — www.everettwa.org <br />�61�. �! n�n, i��. r�t8l�(/'�-� <br />�Q l.S ��' �' s� s� �s� <br />PROJECT ADDR�SS <br />� �s <br />��� <br />c��xl �',�1���.._ �" ���.-- �s`' �'�"1i� �T, 9�1-�� �, o U <br />Owtlef Mail Address City State2i� Phone <br />Tenant <br />Electrical Contractor <br />Nlail Address <br />Mafl Address <br />Stat��s���1 � �p _ <br />�°o��f.���� /�i�1Li �/� <br />Proposed Uso o Building <br />Square �aotage (If residential new construcfion, ramodet or addition) <br />Number of devices (1f low voltage) <br />City <br />City <br />Description of Work to Ba Done: �� ���' ��/Il��'�!� <br />CITY OF EVERETT t�OCAI. SA��S TAX COpE IS 3105 <br />State/Zip <br />StatelZip <br />�? c� � � c���-� <br />Contract Prfce of Work <br />Contact Person (Pian Raview) <br />1 hereby certify th�t I h&ve �sd and exam�ned thls applicatior� and know the same to be true �nd <br />correct. All provisions of faws and or'dinances govemJng thls rype of woNc wil! be compteted <br />wh�thsr specified hen�In or not. iha granting oia pem�lt does not pTesume to give authorify ta <br />vio(ato or canco/ tha provisions of any othet state orloca! laW �gulating construction or the <br />performance of constructlon. That I am authorized by iha owner of th/s praperfy to perl'orm the <br />work for wl�rch Applicatiorr is made and / comply wlth the State Contractors Law 16.27 RCW and <br />29�.20o WAO?, <br />re <br />SED 3i2CYt 3 <br />lo <br />Phone <br />FEE �„ <br />ri,� C�' <br />P�RM1T# <br />� ;1� j �� l ��-1 ���� <br />