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age: 2 08/5/2014 03:06 PM 'C0:14252578857 FROM:5099570051 <br />ELECTRICAL PERMII' APPLICATIOF� <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - t+nvw.everettwa.org <br />/C� � i /��i�✓; fI �1A �PD <br />PROJECT ADDRESS <br />""� �Ti �.r� <br />Owner <br />Tenant <br />'�'y%n L � t <br />Electrical Contractor <br />/a/�/ <br />Mad Address <br />Mail Aatlress <br />�c.- /.S�GX <br />MaOAddross <br />/'i/���c/�r '/ �'cr/ J� /..� 'Y <br />State License Number <br />ProposeA Use ol Bwlding <br />Square Footage (If residential new conslruction, remodel or atlditionj <br />Numbor of devices pt low voltege) <br />�e;cripUon ot Work l0 8e Done� <br />C�TY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />k.o Ed, <br />City <br />City <br />l'Y/t��f"�-' <br />G�ry <br />�� �r(� � <br />E:�,b��a- <br /><�,�ry����� y ��5 =.35 � �y <br />�Slate/Z�p Phanc <br />SWtoIZiP Phone <br />!,G'r'fJc?�.�L��i �:25 �Jo�3-E� �%i <br />Slate2ip Phono <br />Contract Pnce ot Work <br />Contacl Person (Plan Review) <br />I hereUy ceridy thef I ha�u raad and examined fh�s application and know tlie seme to be t�u� and <br />correct. A!lproais�ons o! laws untl orAinances qovoming this fype o7 work m!I bo completed <br />whefher spoci(od herern or nof Thc granfing o!a permit does not presume lo give auflronry lo <br />violafe orcancel the provisions of any othersfafe orlocallaw m9ulafing consWc(ion orthe <br />peAomrence ol construction. That I am aullronzod by fhe o�vner o! this property fo pedom� fhe <br />work lor which applica6on is made and I compty wifh fhe Sla(e Gon7racforS Laiv 78.27 RCW and <br />296.200 WAC. <br />nev�seoar.an <br />�« E�����1 <br />FEE <br />�� c� <br />PERMIT# <br />E���g _ (�2g <br />