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01-26-15;09;59AM; <br />;208 777-7766 # '1/ 1 <br />�LECTRICA►,L PERMIT APPLICATION <br />CITY O� EVERETT PERMIT SERVICES <br />!� ` 320� CEDAR STREET, EVERETT, WA 98201 <br />' 425-257-88'!0 - FAX 425-257-8857—www.ev�rettwa.org <br />i� <br />�q 3�-ti �S-t7 <br />PRO.l�C7 ADDRESS <br />� ► � q�-ao1 <br />OwnOr MeEI Address �Ity State2lp �OL��` _ t�p� <br />�G( <br />Tenant Mal! Address , Clty S1atelZip Phona <br />Contractor Mail <br />� $� � � <br />Stst@ LiCense NumbeP <br />Propased Use of Bullding <br />Squsre Footage (If residontia) new constructian, remodol or addition) <br />Number of devices (If lowvoltage) <br />City <br />sta►�z�p <br />�'�DO. o0 <br />Contrack Prica of Work <br />Phone <br />�l� � <br />�vntact Person (Plan Review) <br />05/ ,��(�� <br />Cs �.�j � CQ,1/��� �' . <br />Descrlption oi Work #o Be Done: <br />1 . � _ - - <br />�. � n <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 heraby certify thal ! l�ave read end ax�mined this appllaaEion and know the same to be �n�e a»d <br />correct. A/l pmvis;ons of laws and ordinancr�s goveming this type of work wi11 be comp/efed <br />whefherspoclfled hereln ornot. ihe granfing of 8 permlt does not presumo to glve euthoriry to <br />violate or cancel ihe provlslons of any otharstAte or foca/ law regulefing construction or the <br />perlorrnai�ce of construction. rhaf 1 am euthorized by fhe ownar of this properfy to perform fha <br />work for whiCh appficat/on !s made and I comp/y wlth fhe 5tete Contractors Lew 18.27 RCW and <br />296.204�WAC. <br />.- <br />REVI SED 3/10/19 <br />� <br />FEE <br />� <br />�� � <br />PERM�'1'# <br />E ���� ���� <br />�— q0 l I �Y C,r <br />�� w�.e <br />� <br />