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10!01;2013 01-.36 <br />:3300 P.001/001 <br />ELECTRI�'AL PERMIT APPLICATION <br />CITY OF EVERETT FERMIT SERu10ES <br />3200 CEDAR ST�EET, EVERETT, WA 982D1 <br />425-257-8810 - FAX 425-257-8857 — wv+w.everettwa.org <br />i �31 l�o�r �.�y'�.— <br />j pFOJECT ADDRESS <br />�� <br />Owner <br />Mall Address <br />Ciry <br />Stato2ip <br />�� <br />Phone <br />7enaflt Mail Address �City State2ip Phona <br />Fcl�it-n►n�,( so��' f'a l3a�c /��� �-f' ��'� �"��./ <br />Ci Stato2ip Phone <br />Etecirical Conlractor Muil Atldress �' ��� P <br />/Zt 'u/ <br />�.�us.� / y�� <br />Scata Licanse Number Contract Price of Work <br />)l�/v <br />Proposed Use of Building <br />Square Foolage (If residential nevr consiruction, ramodel or addilion) <br />Number of devices (Ii low voltage) <br />pescription of Work to Bo �onu: <br />CITY OF EVERETT LOCAL SALF.S TAX CODE IS 3105 <br />Contact Person (Plan Review) <br />� <br />1 hereby certify lhaf 1 httve rend and examined thrs application and know fhe same fo be true and <br />correct. All provisions ollaws and ordinAnces goveming this type o(worlc will po comploted <br />whetharspaci�od harern or not. 7he g�anting o/ a pertnit does not' :�sull7e fo glvo authonty fo <br />violote orcancel tha provisions o/any othar state orlocal iaw regi ng consWetion o�the <br />perfortnance o/ conslructian. 7hat 1 am authanzad by fhe ownarol tl�is property to pe�lomt the <br />work for which applicafion Is mado and 1 comply wifh Iho Stafo Conffactois LAw 18.27 RC W and <br />296.200 WAC. <br />�� /P //✓_� <br />�:v„ <br />FEE <br />��@0� <br />P[RMTT# <br />E i3��� —cc�� <br />