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NOV-05-2013 02:16 From: To:14252578857 Paee:2�z <br />� ` <br />ELECTRIGAL PERMIT APPLICATION <br />CITY pF EV�RETT PERMIT SERVICES <br />3200 CEDAR S7REET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www,everettwa.org <br />, <br />PROJEC7 ADDRESS <br />G t Z�. <br />Owner <br />Tenant <br />Electricaf Gontr�e.to� <br />State License Number <br />e��; <br />Mail Addres� <br />Mail Address <br />Mail Address <br />�S �� o,�n ���. <br />Proposed Use of Quilding <br />� <br />Square Footage (If residentlal new construction, remodel or addltlon) <br />IVumber of dovices (If low voltage) <br />Description of Work lo Be Done: ��( \� i <br />cirY pF EVERET7 �OCAL SALES TAx CODE IS 3105 <br />CEty <br />C;ity <br />a�; <br />SIAte/Zip <br />State/Zip <br />5tate/Zip <br />� �z�� �o� <br />Phone � <br />D V " ' <br />Phono <br />Phone <br />ContraCt Price of Work <br />Contact Person (Plan Review) <br />I hcreby certify that I have read snd examir�ed tnrs applicaflon srrd kr�ow the san7e to be Ertie ancl <br />cvrrect. Al! provls�a»s ofl�ws and vrdinances goveming this type of work wil! he complcted <br />whether spec;fied herein or not. The gr�ntiny �f a pennit does not presume to give authorlty to <br />violete or cancel rhe provisions o( er�y other state or lo !aw regulsting r.onsfn�etion or fl�e <br />perfom�arice uf construcfion. That I am aulf�orizcd d e ownBr of ti�rs property to perform the <br />wafc tor which applleatlon is rnade and I cnmply wf hC State Contractors Law 18.27 RCW and <br />296.200 WAC. n % r <br />. <br />fiEVISED .?/JMi 1 <br />� <br />��� <br />FE� <br />�� � <br />PERMIT# <br />E ���I—. ��� <br />