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03/21/2014 13:36 253-631-7754 PROVTDEVT ELECTRIC PAGE O1/01 <br /> ELECTRICAL PERMIT APPLI�ATI(�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET', EVERETT, WA 98201 <br /> 425-257-8810 - F1X 425-257-8857 —www.everetiwa.org <br /> APPI.ICATIONS ARE ACCEPTED FROM B P.M TO 4 PM <br /> �a-� � �� � S?' <br /> PROJECT ADDFtESS <br /> �omer�sl�ine. es I'-1�2H 1v�ll Cr�u.l� c� qSnBz �-2S-z�8�`I� <br /> Owner A7eilACdress Ciry St6telZlp Phone <br /> Tenant 67a11 AOdross Ciry SlateJZip Phone <br /> �r�l�,���.�c. ���g�1 CvJin�. C�i�`-la-z53-c�i-��� <br /> Elech�ca�Contraclor MailPddross Slaee2ip anone <br /> Vz�.�io3c� <br /> Slate Licensc t.�mber Co�rice of VYork <br /> Proposed Usc of 8uilding Contact Po o �an Revie� <br /> DescripGon of Work to�e Done: v "" �_�L(YL�lJ��.�/ _ <br /> _ ' <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE I <br /> E3E IN RACEWAYS, MC OR AC CA�LE �� O(� <br /> � <br /> CITY OF EVERETT LOL'A�SALES TAX CODE IS 3105 /'� � <br /> i hereby certily lhaf I have reatl and exammed this applicatlon and know Ihe samo to be hue an,i �I� D� � (�/ <br /> correcf. All prov�sions ot laws and ordinances goveming lhis typo ol worir will bo complo(ed <br /> wholhQr spocified he�ein ornot. Tho granting of a pormit does no!p rosume to grve authonty�o <br /> violafe or cencel fhe provisions ol any ofher sta(o orlocal/aw regu/aling consfructlon or fhe <br /> performance of consl�ucfion That I am aulhorrred by lhe owner ol this propeRy to poAorm Ne <br /> roork lor which applica0on is made and 1 compty with tbe Stato Conhact�rs Lew 78.27 RCW anU <br /> 296.200 WAC. <br /> �� 31� ��� <br /> Signature Date <br /> t�lI� <br /> T <br />