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4253428926 40 133:31 a.m. 11-06-2013 1 /1 <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 /> ( Od t s Mom k -AMM {zip <br /> PROJECT ADDRESS <br /> FA P-o N 15p, p6 t-L 1013 t 5 /110 rJ A-t-+a (ZOO ie L)F w a z�y L(75- <br /> Owner Mall Address City StatelZip Phone <br /> Tenant Mail Address City State/Zip Phone <br /> Electrical Contractor Mail Address City State/Zip Phone <br /> State License Number Contract Price of Work <br /> �—oFA c?c Q spcoe z <br /> Proposed Use of Building ` Contact Person (Plan nReview) <br /> Square Footage(If residential new construction, remodel or addition) <br /> Number of devices(If low voltage) <br /> Description of Work to Be Done: A DED AM P Sy <br /> 1 N A IME-C,) CARA GE 4-0 <br /> AN\D MAnl > tZo v ov-TLE7-5 t6t�"t5 <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 �� �� <br /> I hereby certify that I have read and examined this application and know the same to be true and <br /> correct. All provisions of laws and ordinances governing this type of work will be completed <br /> whether specified herein or not. The granting of a permit does not presume to give authority to PERMIT# <br /> violate or cancel the provisions of any other state or local law regulating construction or the <br /> performance of construction. That I am authorized by the owner of this property to perform the E 1 3 1 l --C)31 <br /> work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and <br /> 296.200 WAC. <br /> Signature Date <br /> REVISED 32U%3 <br />