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11/20/2013 21 03 <br />x3599 P 001/001 <br />ELECTRICAL PERMIT APPLICATION <br />C1TY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 96201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />Ce j G 5 �� p`�v�r I �u l <br />PROJECT ADDRESS <br />N ICK� <br />�wrcr <br />Tenant <br />Mad AtlCross <br />tAoil: Cdress <br />Ci1y <br />Ciry <br />y� <br />� � <br />�0 7 �>3 y <br />Statc/Zip �r Phonc <br />StntelZlp Pnorie <br />`��r��'c ��� �'6 �� eY�p �i �'�� Y�s �9��i <br />E;ecuical Contractor blad nadress City siate/Zip Phone <br />��N� � Y�� <br />Sta�a Lieense Num6er <br />J�iL <br />Praposed Use of �uiltling <br />ISquare Foetage Qf resldenlial nnw construction, rnmodel or ad4iUon) <br />Numbdr of devices (If low valtape) <br />� Descnptlon of Work to Ba Donn: <br />I <br />CIN OF EVERE"TT LOCAL SALE-S TAX COp[ IS 3105 <br />� y �o .� <br />Contract Pnco of Work <br />Contact Porson (Plan Review) <br />II hereby cartily that I hovn road and nxamined l/ris npplicndon end know th� samn to bo lruo and <br />r.on�ct. All prowsions o/Imvs end ortiinn�icns pnvomrng thls type ol work wifl po compl�red <br />Iwhelh��i speclfied hon;�n ornot inu granf+np ol d pormif does not prasuma to givr authonty to <br />�vlolalo or cancel tne provi ^icns ol any othar sfafo o� lace/ law regulahnq Construchon a� thv <br />peAomtance ol consfrucdon. Tha! I am ou7honzod by !hd ownor a/ this propoRy ro poAorm Iha <br />Iworkloi which epplicplion Is mada and I comply :vdh thn S�ete Contmcfors Law iB.27 RCW and <br />29d.200 WAC. ,// <br />FEE <br />��OD <br />PERMIT# <br />E I -15� <br />