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03/05/2013 20�01 <br />tl3737 F 001/001 <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EV�RETT PERMIT SERVICES <br />3200 CEDAR STRE[:T, EVERET7, WA 98201 <br />425-257-8810 - F�X 425-257•8857 — www.everettwa.org <br />°�C� ( �, <br />%C-�{-N � <br />PROJECT ADDRESS <br />Ow11ef Mml Addtcys <br />Tenant lAail Addrecs <br />s�< l'o /� <br />Eleclncal Conlractor Mall�dtlross <br />�9���i�1u� <br />Slate Licensa NumDer <br />P�'oP � <br />Proposod Use of Building <br />City <br />%2 l2i�N/� <br />C�ry <br />ly3% � <br />Ciry <br />Square Foolage (I( residential new conslrvetion, temodel or addition) <br />Numbe� of devices (If low voltago) <br />Deseripuon of Work to Ba Done: nf L �( . TiL'/1 f[�C� <br />CITY OF EVERETT LOCAL SALES TAl( CODE IS 9105 <br />�j - b �� <br />C�13�i-��-c� <br />StatelLp <br />State/Zip <br />Phonc <br />� 3 o SS T�-7� <br />Phone <br />ls� �/ Lt / <br />StatelLip Pl+onc <br />� Ci G o o ��u ��� <br />Contract Pri oi Wark <br />Contact Person (Plan Review) <br />! horoby coRily that 1 have rond ond examinod fhls applicalion and know tha semo fo be Nue and <br />^_oaect. All prov sions ollaws and ordinances govoming fhis rype of woAr will be completed <br />whethar spac�ed herein ornol. Th^ gmnfing o/a permlt does nof prosume fo g'rve aufhonty fo <br />vlololn or cancol thc provisions o/ any ofherstete orlocel lew regula6np consbucfion or fho <br />poAormenco al conshuNion. Tnat ! am outhorizotl Dy Mo owner of thls proporty to po�)omi fho <br />wak lor whicii ep caG'on is matlo entl I Comply w�7h fha SYatd Confracfors Law 18.27 RCW nnd <br />296.200 WAC� <br />G <br />� e �t,L � ZS 2.31 � 2`�:� � <br />37fV19 <br />FEE <br />�� 0p <br />�. <br />PERMITk <br />E13oq - 030 <br />