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5-p.i�;. �(It! y:2�nL1 Spun; Ssiurity Ini <br />Na 9126 �'. 1/1 <br />ELECTRICAL F'E�2MIT APPLI��TION <br />CITY OF EVERETT P�F��1,IT SEFtVICES� <br />3200 CEDAR STR[ET, EVEREFT;, !NA 98201 ; <br />425-257-8�10 - fF� 425-2b7-8857 =;�iw�.everettwa.orp <br />� 5c� j �l G <br />PROJECT ApORESS <br />Owner ' tdo!I Address ' <br />Tenonl � Me!IAddress <br />(�( i�rru'ct, S�' <br />E�eC,�lcal Contractor nMll Aadress <br />SoN �T�'�-9�1�b7 <br />S1ate Llcenso Num6er (requlrod) <br />�',ii��-S I�-V�L;I <br />Proposed Use of Bullding <br />Squere Footage �(If resiAentlal naw consWction, romodol or atlditlon) <br />Numher o( devlcuG (II law volinge) <br />�oscription of Work lo Bo Oono: <br />City <br />Cty <br />Ciry <br />�—�-�"�li <br />��3iuo�-n�y <br />SIntWZIP 11z� P�ono <br />�r <br />Slole2ip �� � Z� <br />9b'2b� ` 25�'3 <br />SlatrILID .. <br />Fhana <br />PhanO <br />f 31�{3 <br />�ity o{ Evemtt BuslnF� L` �� um�raqwrod) <br />,.}— � c_ <br />�r � <br />Controtl Pdco of Worfi <br />�Ic.�( �f2S-97�-�,5��-. <br />GonL�ct Pc nlConlact Numbor�Ema�i <br />CfTY OF EVER[7T LOCAL 9ALES TAX CODE IS 3105 <br />1 hom6y coiIIly fhaf I havo /oud and ex�mined Uils applicntion m�d kROw Nlo same fo 6c fnl0 and <br />corroct. NI n�vlslons ol+aws onv ontlnancos goveming thls fypo o� wvrk w1116o eomplofed <br />v�hetherapociflod hereln or noL 7n� y��nting ol e pormif doas nof prosumo fo givc oufhalty fo <br />vlolofo or canccl tho prov+sions olurry Who� s�ata or Iocnllaw /Ogulatlng consWcllon o� fhn <br />peAormonco o/ cansfrucUon. That 1 nm authodzod by the owner ol thls p�porty ta poAorm tho <br />work lor whidi eppllcnfion is made end I eompty wifir tho Stato Canlmdors Law 1B. 7 RCW and <br />z96 A�.n 0�. � G DDo o Q' � �.�� I 5� <br />pFt9•.ED OS'CB7Ji� <br />fGE <br />l� i <br />PEfiMIT# <br />E �1�'0�(—D� <br />