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07i`1712013 �J. J1 36082917� �;�v1ERICAN ELECTRICAL P�GE 02:'d2 <br />• <br />ELECTRICAL PERIVIIT AP�L�GAT�ON <br />CfTY OF EVERETT PERIIAlT SER'VtCES <br />32Q0 CEDAR STREE7, EV�RETT, WA 98241 <br />425-257-8810 - FAX 425-257-8857 — www-everettwa.org <br />����_���� 5����. 1 <br />PROJECT ADDR�SS <br />Owne� <br />�vteil Addr�ss <br />y yh <br />City <br />5tate/Zip <br />9��� <br />�a �,� � -3 Yy <br />Tenant Mail Address City State/Zip Phone <br />Contractor Mall Address <br />���� 'Q�� � <br />State icense IVumber —'�'�'�� <br />�� 1 L ar-� e.l �°J r�.�) � <br />Prop ed Use of 8utlding <br />Square Footage (If residential new constructiorl, �emodel or addition} <br />Nurnbor of devices (If low voltage) <br />�j c.�c I�1- c y C.�1- `��3v� ( �� <br />Ciiy Stsie/Zip Ph4ne <br />0 1� <br />Co tract Price of Work <br />Contact PErson .(i'lan Review) <br />Description of Waric to Be Done: ������7 �!�y �'Z ��- �Gt� I��� C[�"�. <br />�rc�h��., ; s` ��C�--a�r �� !� � � � S 7 � -; <br />CI7Y OF EVERETT LOCAL SALES TAX CObE IS 3105 <br />1 hereby certify thaf I hsve resd and examined thls epplication and krrow the same to be true and <br />correct. A/l provlslons of laws and ordi�encas goverr�ing this type af woric will ba complotsd <br />whether speCifled hereln of not. The granting of a petmit does not p��esume fo give authority to <br />violate or canCe! the provisions of any other stste orloeal law rogulating Constluction or the <br />performancn of construction. That 1 sm authonzed by the owner of this property to perform ihe <br />worlc for which application is msde and / camp/y wiEh the Sfate Gantrecfors Law 98.27 RCW and <br />29fi.200 WAC_ � � . <br />REVlSED <br />FEE <br />�. �. � _�} <br />P�RMIT# <br />� � ��'\ � � ��f �l � <br />