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05!23/2012 11:02 4254854320 HILL ELECTRIC <br />ELECTRICAL PEitIVIIT APPLICATION <br />CITY OF EV�RETT PERMIT' SERVICES <br />3200 CEDAR STRE[T, EVERETT, �NA 99201 <br />425-257-A810 - FPJC 425-257-8857 - wv✓w•everettwa.org <br />pppLICATtONS ARE ACC[Pl'En FROM 8 A��lf TO 4 PM <br />85a� `I�h /av� SE E�lece-4k- WR `1g�.Og <br />PROJEGT AI71]RESS <br />CIa�G: �elSon g5aa- q'h <br />Owner <br />Tenant <br />4��11 �lec�t�� G� <br />Elochical ConVaclor <br />Mall Address <br />Mnil Adtlrcss <br />bratvn �C� <br />H� LLEC� O�S3°I <br />Stato License Number <br />Propo�aU Use of Etuildiag <br />A1ali Address <br />SE �JE�e i'� <br />ciry � <br />;.�_nde � �o <br />Square Footago (If rasidential new constru�t�on, remodel or addition; <br />Description of Wark to Be Dona: i�� <br />r; <br />G',CLu��� <br />d <br />NOTE �WIRN RAC WAYS MC R AC CAB aUIREO 70 <br />CITY OF GVERETT LOCAL SALES TAX CO�E IS 5105 <br />1 hereby certi(y tbat 1 have iead and exnmined this applrcafior. <br />correcf. All provisio�s ollows dnd ad�nancos goveminq thls <br />ti:-hether spocified herein or noL Tlie granfiny of a pe�m�t doe <br />vrol�te orcancel the provisions of any ofherstate or local law <br />poifomiance ofconshucfion, That I nm au0ianzed by fhe ow� <br />viork (or which applicalion is made and ! compry wifh fho Staf <br />296.200 WAC. <br />Gity <br />City <br />PAGG 02/02 <br />5-a 3-�z <br />C� ��s��' � <br />WA ig�o8 <br />Slate2lp <br />Stale/Zip <br />,v',I�� 'vUA `� 0�2, <br />Stato/Zlp <br />Phone <br />Phcne <br />Fhone <br />ConUact Prica of Work <br />�oqe� ��� 11 _ <br />Con ct Person (Plan f2eview) <br />. S�elcca��nc ��d Arn� secv� <br />S—c� <br />�� <br />FEE <br />(✓�O <br />to be true and j— <br />ompfeted t= � a'_ 0�' I I <br />3 authoriN to <br />or <br />