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v� � G o-� - y��Z � — _ <br /> �LECT'RiC�4L P��ii�l� A�I��.B�A I���iV <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 96201 <br /> 425-257-8870 - FAX N25-257-8857 —wwv�.everettwa.org <br /> Erso�-oas <br /> �./, Z� Coc.i3X !�/�= � �t� � -G -t 5 <br /> PROJECT ADDRESS <br /> f JT���.v ��f� -1��� /ZS'o.� 2� r�i pG�v�.�1�!/�2z�TT Gi/� �� `{ <br /> Owne� �dailAddress C�ty Slate2ip Phonc <br /> � <br /> �oo�/G���r1�.�r�Zy s�o�Z�' i%7.�'/-'n�"T ,�/�- 9 8 2e l � 9�� . <br /> TCnant MatlAdtlress C�ry Stale!2�p Phone <br /> �oTNG� ��r-,e� /��'.�L�-✓� IBIII 9�.9ri�J✓G=�3a>/�z�GL !�/�- ��o� <br /> [lecirical Coniractor Nlail Address C�ty StatelZip Phone <br /> � I ln I�vA(� S S��2l oSN`� <br /> Slate License Number(required) Gty�ret� Business License Numt•er(required) <br /> _ Q OOI� <br /> Proposed Use of Ouiiding C ntract Pnce o1 Work <br /> Square Foolage(If residential new construction,remodel or addition) Contacl Person/Conlact NumbedEmail <br /> Number of devices pf low voltage) <br /> ' 1r /: ��G�lt�cel <br /> Description o(Work to 4e Done: � � N�LI I� �l� ���I�V � a I I vt <br /> �I� tilvi r r,� �� fit,v��t,+� t" 1 rn ,� rr�• <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 ,�,'��� <br /> I hem6y certi�ylbat l have read and ezarnined this applrcafion and kno�v the same to be frue and <br /> co�rect All provisions olla�a�s and ordinances goveming lhis type olwork will be complefed <br /> v,�hefherspecified berein ornot. The granting o(a pemti(does not pmsume to g�ve authonty to PERMIT# <br /> violate or cancel the provisions o1 any o(herstale or local laiv regulafing construclion orthe r I f��_ T�� <br /> perfonn o co struclion. Thaf I am authonzed hy Ihe o�vnero/fhis properiy fo pedorm fhe C �, U <br /> �roo or�vhi ap licafion is made and I compty v,ifh fhe S(afe Confractors Laiv 18.27 RCW and <br /> _6.20 AC <br /> ^ / r/. <br /> � J <br /> Signature Date <br /> , I <br /> fi[Y�SEOCflVS^.Of� -- _ �I <br />