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� <br />� <br />ELECTRIGAL PERIV�NTAPpLIC�T�ON <br />CITY OF �VEI�ET`I- pERMN`T S�RV�CES <br />3200 CEDAR STREET, EVERE7T, WA 9820� <br />425-257-8810 - FAX 425-257-8857 — www.everetly�,a.prg <br />E � y � � � r�1 �1 ��, �/� r�e , W�I � ��� - 6 � . <br />pROJECT ADDRESS � � � ,� <br />/� �z (..�5 N�1�T%► c.Y <br />Owner <br />Mail qddress <br />' ��c <br />7!1 s�f 1i6 C ' �!'i'� �11 <br />City State/Zlp <br />� a N�- a.5 �W �,z„r ---� G% JU � C.� <br />Tenant Mal! qddrass <br />Ci�y State/Zip phone <br />S� C �� ��-h��s �� w.� o�c:� � 3� <br />:iac ical Contractor Mali Address Cfty <br />0 .�.7C� � �� 1 �� <br />State Lic�nse Number (required) <br />�,' I lh� �'lc� ' - � �.�' c- • � � <br />Praposed Use of Building � ' <br />� � �� '� <br />5 <br />Square F otage (ff resident�al new constructfon, remotlel or addifion) <br />! �1 <br />Number of devices (If law voltage) <br />D�scription of Work t� Be Done: �Jj �� <br />lo ��. �tK,-� . <br />C1TY OF EVEI�ETT LOCAL SALES 7AX COD� 15 3705 <br />`� 0�-f (D �-125 Z`I <br />St1le/Zip Phone <br />�� ''--'�. =� <br />City of Everaft Business License Number (required) <br />� � <br />Contract Price of Wark <br />�1� "l �f � ZA "a �� � ct �� <br />Contact Person/Contact Number/Emait <br />rr�c���v �ys1�►� s �j�i�F����' wa� <br />/ hereby ce�fify that ! have read and examined thls applrcatioR end know the same to be frue aRd <br />correct. A/I provrsions of Jaws and ordlnances governing thfs type of work wil/ be compfeted <br />whether speCilred hereln pr not. The granting of a permlt doas nat presume to glve authority ta <br />violate or cance/ the provfsions af any ofher stat�� or loca/ law r�qulatmg co»st�uction or tha <br />performanca of construetion. 7"hat / am authorized by th� owner of this prope�fy fo perform the <br />work fo� which applicatron is made and ! comp/y wrth the Sfate Contracto�s�L�w �8.27 RCW and <br />296.200 WAC_ <br />REv�s�p ouroc2o�.r <br />FEE <br />�'�� � r% <br />PERMIT# <br />E I �� - ���j <br />ze�ze ��bd ss� 8LBZ6bZ5Zb 5z:ei 5iez�zzftie <br />%� <br />