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65105!'2015 11:02 4256703922 ACTIVE ELECTIVE P�;GE f�1%'01 <br />� �"� � o� � �c� CG�CI y � N�� �� �� -�-�.�,,� <br />�- �� �Q� C � <br />�� <br />�r� � ��- �— � !�� o� <br />i�LE�1"RI�e�L P�R1V��T e�PP�L��A�`��N <br />C1TY OF EVER�TT PERM�T SERVICES <br />3�00 CEDAR STREET, EVER�TT, WA 98201 <br />4-25-257-8810 - �AX 425�257-8857 —www.everettwa.org <br />APPI_.ICATIONS AR� ACC�Pi'�d FROM 8 AM TO � PM <br />'� '�" <br />pROJECT ADpRESS <br />Owner <br />Tensnt <br />Electrical Contractot <br />Mail Address <br />Mal) Address <br />� I�� 11 1� <br />Mail Add�sss <br />��f 1�� �o��� <br />State Ricense Number' <br />Proposed Use of I3uildin�j <br />5quare �ootafle (!f residentiaf r�vw-consfruction, rernodel or addition) <br />Description of Work to Be �]one: <br />NOT�: WfR1NG iN NOM1!-DW��LINGS IS [��QUIRED 70 <br />B� IIV RACEWAYS, MG OR AC CABLE . <br />CiTY OF EVEREYT LOCAL SALES TAX CQDE 15 3105 <br />State/Zip <br />Phone <br />5faf9/Z�p Phone <br />,�..� �25� , . <br />State2ip <br />� �� �� <br />Contract Price of Work <br />Cvntact Persori (Plan Revlew) <br />1 f�ersby cerfify thaf ! have read and examined this appl�cation and kno�v the seme to be trua snd <br />corract. All provisions oFlaws and ordinanCes goveming fh,1s type of �vork wil! be eompleied <br />wheEher spsci�ed har�eln or noP The gr�ntiny of a permrt does not presurne to grve �ufhorify to <br />vio%te or cance! the provrsions of any otherst�fe or'locel le�v ragulafing consfrucfion orthe <br />pe ance ofconstructron. That! am authorrzed by the owneroftf�ls pruperly to perforrn th� <br />work whlCh applicaflon made and 1 comply wrfh fhe St�te Confractars Lsv✓ 18,27 RCW and <br />295.20 WAC. � <br />D �1 � �` 0 � �l.l�f'�/� � <br />Phone <br />�EE <br />-� � OU <br />� <br />��5�5 U�C� <br />