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Lio <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF E�/�RETT PERMIT �ERVICES <br />3?_00 CEDAR STREET, EV�RETT, WA 98201 <br />425-257-8810 - FAX 47_�-2�7-8857 — www.everettwa org <br />/3���Y c�ti <br />PROJECTADDRESS <br />Oemer <br />Tenanl <br />Wail Address <br />Mal nddmss <br />CAy <br />CAy <br />Statc2ip <br />Slate/Zip <br />5-ao-��{ <br />C- iyos-� 23 <br />Phane <br />Phcne <br />/�u �,.�✓ �z�nuc rg as yh:+�!%SE- _/3vfift��LC- w�A 9�a'Z �/Z`� • 3�7_�fo/g <br />EleclricalConiractor �dailAddresrs Cily .`tale/Zip Phone <br />/-�c,(,cvC,� 90 / L G <br />Slale License Number <br />Proposed Use ol �uiiding <br />�CY1Zi `J% —h-h' <br />Square foolagc ( residenlial new cm�slrur.tion, remodel or addiUon) <br />Number ol Jevices (II low vol�ayr.) <br />S4CJ7� •`'U <br />Conlract Pnce of Work <br />Contacl Person (Plan Review) <br />Description of Work �o f3e Done: _ 2� %�k'1� �Gi<<//�_ __C�i�l4LV�E.__�'/.�(/ �. . <br />_/=uncc�r2 �'G��c�iLr� __ifL�r�rLS , ----.--- - -- <br />CITV OF EVERETT LOCAL SALC-5 TAX CODE IS J105 <br />! hereby r.r,rh(y Ural 1 have read and exarnined Ihis .ipplir.n6orr and knowlhr, samc fo hc truc �nd <br />roncr.L illl pmvisions ollaws and ordinanr,es goveming Ihis typc c( work will he r,omplefed <br />tvhelher specilir,d hmein nr noL The yrinfiny ol a pernrit docs nof prr.sumc to givr, aidhoiity fo <br />vmlafc oi canr,cllRc piovisions o/ ��ny olher sfafe or local law reyulafiny rnnsfruclinn m'!he <br />peifontronce o/ consfn�r.lian. Thaf I nrn a�dhonzed by O�e owner olllus prope�ly lo perlonn Ihc <br />�vork lor which opplicalion is nrade and 1 rornpty tvifh flie Slafe Con6aclors La�v 1U2' CCW ��nd <br />296.7.OU WAC. <br />,_z.,�.� � /20 /2G i `/ <br />- - ------ __ _ ---- -- ---- _ .. _ . <br />�iire __ Da�e f . <br />r-�r---_ _- -- -- <br />8G°° <br />PERM: iN <br />E1��5-iZ7 <br />