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10:3d�.58a.m. 04-29-2013 2 'z <br /> -10 <br /> ELECTRICAL PERMIT APPLICATlON <br /> CITY OF EVERETT PERMIT SERVICES I1 <br /> 320D CEDAR STREET, EVERETT, WA 982�1 �i"�+�3 <br /> 425-257-8870 - FAX425-257-8857-www.everettwa.org �'��� ��� <br /> 33�d Pa�ne 5} Evece+l- + v�R qfi� <br /> PROJECT ADDRESS <br /> Owner Mall Address Glry SlateflJp Pheno <br /> Cucr�l�da�d CIP�+r [ 3yoR>.'neS{- fiveree-�- WN q82o1 '�tcp-��- <br /> Tenanf �'Sn�h�tU'S Mail Address Clry StatelZip Phone <br /> a�m�tc Sewr+y � Comm 1�.0• i3ox 355T�1 Arhnr��m WA 982a3 3�-�2-�aB <br /> ElecIdC21 Conlfaclor Mall Address Gty S�a1rJZip Phone <br /> Olymt�ol2a� lime .�Ma�k.rlu..0 <br /> State Licenso Number � ConVact PAce oi VJork <br /> 3t�o- � <br /> !-leadher���n�a Io88 <br /> Proposed Use of Building ConWcl Person (Plan R�view) <br /> �C'SS 11nc.n � OD6 st, F+. <br /> Squaro Footago(If residential new consWclion,remodel or addNon) <br /> („ phonefDAT/� Cvmtx� <br /> Num6or of devices(If Iow vollage) <br /> Descripllon of Work l0 8o Donn: 1]��i-i'ii� � �D �`lC��� ���'��fe �Qri'S � (l <br /> e, • 2 oC�,�ce <br /> FEE <br /> CITY OF EYERETT LOCAL SALES TAX COUE IS 3105 ����.( �� <br /> I hereby certily Iha�1 havo road and examined fhis application and know Ihe same ta 6e fnro and <br /> corracf. All provisions of laws and ordinances goveming fhls fype o/work will be comploted <br /> whether specified herein or not. 7he granting ol a pertnif does not prnsume fo give aufhori(y to PERMIT# <br /> violafe orcancel the provislons o/any ofhersfale orlocal faw regulafing consWcfion or the � ; , I (� �� <br /> pedormanco o/consfruction. That I am aufhonzed 6y fhe owner ol fhis propertY to pedorm fhe .�C� � <br /> worR lor which application is made and I comply with the Slale Cont�acfors Law 78.27 RCW and <br /> 296.200 WAC, <br /> ���.,�«Q��� �ZR�� 3 <br /> --�naWre Oate <br /> � PCv�S!'O3:Pf3 ���_ _ <br />