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OCT-10-2013 14�44 EL �RI—CITY � 425 672 6799 P.01i01 <br />y/" /�� <br />z%� � <br />PROJECT AbDR�SS <br />��, s �, �1 <br />'� Owner <br />Tenant <br />G / <br />Electricaf Contr tor <br />State ticense um6er <br />� ���L� <br />Proposed Use of 6uifding <br />�LECTRICA.L PERMlT APP�.I�ATION <br />GITY QF EVER�TT PERMIT SERVICES <br />3200 CEDAR STRE�T, �11�RETT, WA 98201 <br />425-257-8810 � FAX 425-257-8857 -- www.evereftwa_org <br />A�PLICAilONS ARE ACC�P'��p FROM 8 AM 70 4 PM <br />QR � � /u'l.J� <br />��Jfc� <br />Matl Address <br />Mail Address <br />Mai! <br />�j CC N.t. <br />Ci� <br />Glty <br />_ ��� <br />Gty <br />State/Zip <br />Stete/Zip <br />�. <br />� <br />Phono <br />Phone <br />S�RelZip Phone <br />' / �, � s� - <br />Contr�ct Price of Work <br />Coniact Person (Pfan F2eview) <br />Description of Workto Be aone; ��"�C- �(a-fiK�� ,��„�..a.��c.� <br />_ /J�..�J /��,b.� ou•:! ,�.� t�,� s � �:.��,�.✓� . <br />NOTE: WlRIA1G !N f�l4(V-DW�LLINGS IS REQEJiR�D Tq <br />B� IN RAC�WAYS, MC OR AC CABLE. <br />CI7Y OF EVER�rT LocA�. SAL�S TAX COn� rs 3� os <br />I hereby ceKify th�t l heve read and ex�mined this applrcation and know ihe same lo f�e fir.re pnd <br />co�rect. All prov,sions of laws and ordinances govenung thls type of work wilf be completed <br />wf�ettzer specrfled her'ein or not_ 7'hs grenting of a perm�t does not presuma to 8ive auil�a»fy to <br />v!olate or cance/ the pra visions of �qy othel' Ste�e or loce/ law iegu/ating coRs(tr�ction or tile <br />perfom�ance of cqRst►'uetioh. That I am aulitorized by the owner of this perty to perfnmi tho <br />work fo� wh�ch epplicefion is made and / comply wrth tHe Slete Contrsc� �ow 18.27 RCW and <br />296.200 WAC. <br />0 <br />/O <br />FE� <br />� ( -I- �� <br />�/�cr s e c��/ �r G��e� Z� Ur�G� �������� . <br />� ( ��D ��DC� <br />TOTAL P.B1 <br />