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� �� � � � <br />-�����-�- � �� <br />r.-� ���� �� ���� ELECT'R�CA� P��RINi1T' APIPL�I�AT#QN ��� ��� <br />�°��' GITY QF �VERETT PE�NlIT �ERVI�ES <br />32�Q C�DAR STR��'!', �V��FTT, WA 9820'f <br />425-257-�814 = �AX 425-�57-8�57 --wwtiv,everettwa,org � <br />��,�� ��.,-+'� ��`�`d�e � r3..�i� �,� �=�`�;�'".� �� ��C?� <br />PROJECT ADDRESS ' <br />� .t.��-f'� U�In�' C ��7�#�Q.�-�'�"`�____._-__-- �.__ __�_�_ <br />OWner Maq Address Clty 3te�a2lp Phone <br />Tej�ar3t Ma�i A�i�iress C(ty ; 8tatsf�(p Pho�e <br />1 t 2,Dt��' s!" �z5 t�7tJ'�vS,�J ���J 3� <br />�`�1V� '�G 1����..����� _ ��3 �.~� � �- �S � <br />E#ectrfeql'Qt�tltractor MaitAddress ' City Stetisl2tp f'tipqe <br />�GTtll����. C}2.6 2.� $ : <br />State L(cens� NUmber (i�qu�red} " C�ty `of Everstf 6usiness Licertss Number Uequlrec[� <br />���-�.-r t���- ��c�.�... � �2� .� <br />��"�� `, ' f'r�posed Use bf Bulldit�g Co1�tr�uf P�cs�of Wotk �� <br />. NA C�'EA�I ;,UJ�lL1,�11�1 �125�218• [ 7{�} <br />Square Fnotage (If residential new consfnf'ation; remodel o� adc$itlon) Oonfaat Parson/ContactNumbedEmafi <br />r /"1 <br />Number o devicee {If low voll�ge) <br />Desctiption of Work to 8e Done: _._� ___7" �4+� ''�" ��•f"� i����`�'_�.� �.,���/�!��_���.[���n,._i_._ <br />FE� <br />CI1fY OF �V��tETf LOCA4 SALESTAX CQDEI$ J105 [�(};� <br />- � r„ , , � � t� . <br />1 hereby cerUfy thai l lieve read arid exa5nined fhls appll�atlo� and know ttte same fo be frue an� <br />correct Atl p�vlstons of laws and orr(inancss gousrrzin� this type of wor}c yviii be cotrfp(eted <br />whefherspecli�ed hetisln arnof: Tlte ytanting of a pennlf does riotpr�sur'rte`R� glve eufhaHfy fo PERMIT# <br />vlolafe orcancel the provlslons of eny other st�te orlocel lr�w r�gu/ating consfruc8arr or lhe ` , l <br />' perfarmance ofcronstnlctlon. TF�af I em authorized ,by the ownerotfi7is prpperfy to perforrn the ��, ,�-�� ,r-�... Ot,..}� <br />Woiis (pr whlah appllcatlon Is tt��de and t� con�ply wjth (�te Stafe ContraQtors Law j8.2T RCf�V �t�d w <br />286.200 WAG�. <br />n.n,�-�- J' .�~ f � <br />�� <br />w_�; _...�...�._�..__�..�. _._�._:_ , <br />na ure Date ' <br />�. <br />REV/5ED 03TiPx�Jt314 ... . � . . � . . . . . . ` . <br />_ <br />.. _. ._. __ ... . .. . . <br />. .. . ..__.....---.�..._...._ _ .. ... __.. --- - <br />._.._......_.___._-. _ ._.. _.. . <br />��� 9��e�: �,�� <br />