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U3/21i2013 14:0� 14257751960 ACTIVE ENGINEERING PAGE O1/�1 <br />ELECTRICAL �ERMIT APPLICATION <br />ClTY OF EVERETT PERMIT SERVICES <br />3200 CEDAR S7REET, EVERETT, �N e9eZe«a.or 3�a� `� 3 <br />q25-257-8810 - FAX 425-257-8857 -www. 9 � 1303�� 5 f <br />ao��- ��u;� }t� ���a <br />PROJECT ADDRESS <br />rnvner <br />TenaM <br />Electrical <br />m�w��w ^�� <br />Mall Addrest <br />Mail Addrtmsa <br />o$ 7co�5�rS� <br />A1all Adtlres^. <br />� ��:�c -�Y �4s ts m S <br />� State Lixnse Number <br />I — <br />I amposetl Use of Building <br />Square Footage (if residentiai newcensWd�an, remode� or addition) <br />I <br />i PJumber ol devices (It low voltoge) <br />pf Worl1iqBC Done: <br />CITY OF EVERETT IOCAL SALES TAX cOD[ 15110s <br />Clly <br />Cily <br />Ctly <br />Slato2lp <br />StateR�p <br />Stalc2ip <br />25o.au <br />CantrdG Price at Wortc <br />Gontact Person (Plan Re���"+) <br />I hr.icby certily thet 1 have reed and examined tnis applico!!on and know fhe snme to 6¢ frue and <br />carect. AN pmvisions of laws and ordinances go�eminp lbls type o1 �vorM witl6e comDleted <br />rmether specified herein or not. The 9rontJn9 of a permit dces not prrsume fo give aufhoNty to <br />Noiafe or cencel !he provrsions ol any other stafe or locnl (aw roya�sting conshuction or fhe <br />poAormance olcarshuction. Thnt l am authonzed by the owner ol fhis proyerty to pertorm the <br />v;ork /a��;l:ja�s,.yy1 '�on a r, nn omply tvitb tfrp Slafe C011trdClors L9tv 1B.27 F,CW Ond <br />Phonc <br />Phonc <br />Phpne <br />r-ee <br />� � <br />i <br />PERMIT# <br />E i �C 3- i51 <br />I .f�..cm�:rr: <br />