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EL�CTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES �i <br /> 3200 CEDAR STREET, EVERETf, WA 98201 �� ���-13 <br /> 425-257-8810 - FAX425-257-8857—www.everettwa.org C.130y�/a� <br /> Zq15 Cc�t-Btl r1vc. PvFQCii' �Pr �P:ZOI _ <br /> PROJECT ADDRESS <br /> �a�iCY �aR�eS 10(a0 NE ICU�`�s' SEAiTLI. W.4 `���ZS Za�-`148 Scnl <br /> o�mer �.+o�i ndaress at� �tolmLp Pnone <br /> CR�V��aCc ('ASl7til GR�L(. 2�ii5 [L�dY AvE �uC�etf WA ���1 �i2s• 37�I-Z48� <br /> TenBM M1ta.l Address Cdy Statc'Zip Phone ��, <br /> APoe�� ,4�c��1 `l�eo �Iqe3eJ� P��zo� Mur��r�o vJa 46275 y25•344�o�y <br /> Ele[iricel ContreCtor Ma�l Address Cny State!L•p Phone ' <br /> ArouMi -o��l- oo � loo,00 I <br /> State License Number Contretl Prite oi Work �� <br /> �f_S'^AU�21�n('I� �4'r RL�4)� ',. I <br /> Proposed Use o1 Bullding Contacl Person (Plan Revlew) � <br /> Square Footage p(residentlal new construtlion, remetlel or etldltionl i <br /> Num6er of devlcas(Il low voltage) <br /> Descdphon oi Work to Be Done NOC1�L l9P 5iG�l i o Ex�ST�►-tG', C.if2c�v�'r — <br /> FEE <br /> �� <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 �� -� <br /> I hvroby cnrtily thet 1 hovo roed and oxpminod fhls eppllcaflort end knav the seme to be hue arrJ <br /> correcf. art pmvfalons ollewa e�M adinencea govemtng thls Npe d work wtll 6e complefed <br /> whether speafiod homin ornot The gran6ng o1 a permK doos nof presume fo grve euthaity to PERMIT# <br /> vrotato orcancel ttw provtalons ol srry o(har ak�te or Iocel law regWuting consln�cGon w dre <br /> peywmence p/consWct�on. That I am auUarized by ffie owneroftlMa property fo perfam the E � "L%� — �vZ� <br /> waK for wl�rch metlon ts motle ero11 compry wrth fhe Sfete Ca�trecfora L�w 18.27 RCW and <br /> 286.200 WAC.�. <br /> �����^ ��5� t3 <br /> 9gno�ro Date <br /> F_�.�:.r.. . .. . <br />