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2q-APR-2013 19:51 From:6191234567 <br /> P�ee:l�l <br /> ELEC�RIGAL PERMIT APPLICA710N <br /> CITY OF EVERETT PERM17 SERVICES <br /> I 320U CEDAR STREET, EVERETT, WA 98201 �`a 5-,3 <br /> 425-257-8810 - FAX 425-257-8857—www.everellwa.org <br /> , �c�3oy--163 <br /> i.. , � <br /> /Ul �'� ��P:f�v`P�°r '+ _ <br /> PROJECT A�DRESS J � <br /> � � <br /> `�i �z. IT2 t� /U ! U3 L- VPre� � '�� L'�l�f 1N _ <br /> Owner MnilAddmss Clty Stato2lp Phone <br /> Tenant Idall Addr�ss <br /> �gy Stalo2lp Phanc <br /> ' So ' L �, ,�����;�, �� C�C�v�ti�'� � �� <br /> IElocirical Contr ctor Mail Atltlress CIry S�atc2lp Phone <br /> �c�a s � E �� Z �2 7_1 � o � <br /> Stale License Numhor CaNrad Pdae of Work � <br /> � �—� � J � <br /> , , <br /> Proposed Uso Of Ouildinp Contact Person (Plan Review) <br /> �`t� ���t I $� Z <br /> Square Fnotage(If residential now construction,remodel or addition) � <br /> l�.iSh�Ss �)�rhr� QSII�aS <br /> Number of devices(If low vol4+ge) <br /> Descripliono(WorkmBeDone: �COI4�e- �2' CCwl2�^ F��WPS(`''�� � �9��5 <br /> UYLO ��'QS� W ! � � Z L�� � 15� (!N[! V� 1 S� �� <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 �� <br /> � <br /> I he/eby ceRily tha(1 h�v0 l88d aild CX81711l1Cd lhls appficntlon and knoa�Ihe seme to be true anu � � � � �""�� <br /> � correct. AJl prvvisions af lews end ortlinences goveming this(vpe o/wark will he compfeted <br /> � whefherspeci(ied horcin ornot. Tha granting o!a poimit does rnf prosume to give au(hontylo PERI�lI7# <br /> violafn orr.anr.ef flin pmvisinns o/Brry o(herstafe orlocnl law 2gu!etinp constniction o�fhe r I�O� _ I /�� <br /> p0Aon712nCB 0/co�)Sfnittion. Thnt I sm aufhonzed by the ownero/tr.is property fa pedom�the C � ���r <br /> work lor wh�ch op /ication is mado and!comply with fho State Contractors Law 78.27 RGW and <br /> 296 200 WAC. <br /> ' - z 3- z�� 3 <br /> Sipnalura nate <br /> FF.v�aF01^•ti13 <br />