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09/03/2014 13:28 14257751960 ACTIVE ENGINEERING PAGE 01/02 <br />• <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.nrg <br />C— � � o� ..do-z� <br />C1629 LVPxGrQan vin Slea�s <br />PROJECT ADDRES <br />ir\ck�n+� 11�� 01(02°( S„P,yare'An wi%� EyP.vrt+ WPgS29y y25•443.1Wj <br />Owner Mail AddrassQ city Stato2lp Phone <br />Ior�s L000.5 9(e7_9 aevr reerl kyAti ZiP 7.03 Eyek t4 W R 98 264 <br />Tonant Mall Addre City Staloop Phone <br />ACiivC 't '(\Q.ehr�l �b05 ?crifz, SfSw Lvr\r,u)ood WA 92036 y2S.�76• llg <br />Electrical Contra r Mall Addrann Clty State/ZIP Ph.,na <br />AciiYe- 0MY"S 000-1-2-1- <br />State License Number (required) City of Everett Business License Number (required) <br />21500 <br />Proposed Use of Building Contract Price of Work <br />-W n SQY till 7Q(n. ( 3.09Qv <br />Square Footage (If residontlal now constuclon, remodel or addition) Conte PemonlContact NumbodEmall <br />Number of devices (If low voltage) Description of Work to BoDono: t3—Y-1ceinA wivIM 4 -to code_ <br />FEE <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 , l �D <br />t hereby codify that I have mad and examined this application and know the same to ha trua and <br />correct. All provisions of laws and ordinances governing thin. typo of work will be completed <br />whether spectCed hemin or not. Tho granting of n permit does not presume to give authority to rEW <br />IT; <br />violate or concol the provisions of any other state or local law regulating construction or the ^D <br />podormanco orconstruction. That I am outhodzcd by the ownorof f/iis property to perform the v <br />work for which application is made and 1 comply with tho State Contractors Law 18.27 RCW and <br />296.200 WAC. <br />I(ACU W-1 <br />Signature D M <br />RFMSFa 08N8?JfA -- <br />