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_ <br /> --- -- - -- _ -- <br /> � ELECT`AL PERMIT AP•CATION , <br /> CITY OF EVERETT PERMIT SERVICES � <br /> 3200 CEDAR STREET. EVERETT, WA 98201 � <br /> 425-257-8810 - FAX 425-257-8857 - www everettwa org <br /> � E � soy_�ZU <br /> � <br /> ' Z S I� �'� c��— � i - �l �� —I 5 <br /> �. _ <br /> ' PROJECT ADDRESS � �, ���� <br /> `J�—i` �� cJ �D 2 S I � C�, ��Z s%�- -- Gr✓L��-Ls� / ) � � , <br /> li OwnC� Maii Atltl�ess Cily Statc�Lp P�onc <br /> � �I�-�L''��_- _ _. ._. <br /> i <br /> Tenanl MaJ�tltlress C�ty SIat�2�p Pnone <br /> I <br /> �t-.�J(Jl�—_.—_ � <br /> ElecincalCoNtactor Ma�lAtlaress Cdy Stare?�G Phone <br /> Slate L¢ense Numbcr (reywred) City of Everetl Bus�ness License Number(reqwred) <br /> ��~ � `�`��" Conhact Price of Work <br /> Proposed Use ol Bwltling <br /> � l,'�� ��00' /� �� ; <br /> Square Footage (H residential new construct�on, remodel or addAion) Contact Person/Conlact Numbed[maJ <br /> NumGer ol devices(II low vnitage) <br /> ` , <br /> IDescriplion of�Vork lo Be Done _�V T-LL j_- ��2 C-H�L.I vc-j _ <br /> — -- - - <br /> f[E- - <br /> CITY OF EVERETT LOCAL SALES TAX COUE IS 3105 � (,�/'1`� " <br /> I hweby certi/y thaf 1 have rend and exam�ned fhis app6cafron and know llre sam�: to be hue and I ___`�`/ _ __ <br /> cunecf NI prov�srons oliaws nnd oidmunr.es govemmg Ihis f}�pe ol work wdl be��omplefed -----� �— � <br /> whefher sper.died he�ern or nol 7he y�.�ntmg ol a pennd does nof presume fo yrve auflionty fn PERMIT# <br /> violafe or canr.el fhe prowsions o/any ofher sfate or local law regulahny consfn�diw�or fhe I � <br /> perlomiance ol construcbon Thaf I arn eufhonzed bv fhe owner o/Ih�s p�oPrrty fo pe�fonn the E I,� U � (�- � <br /> wo�k lor whicb appGcaf�on rs made and I cnmpty wrfh(he Sfate Conhncfors Laiv 78 2'RCW and � .____ ___ _. . . <br /> � 296? 0 WAC <br /> � � �1• 'Zl l � <br /> — g�gnature- -�--- — �-- - -- Oaie <br /> RFPSR OR46?J i�� <br />