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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 G --11�-1 S <br /> 425•257-8810 - FAX 425-257-8857—www.everethva.org C i5D6 `�(� <br /> Z`133 Cv�n�l A-�� <br /> PROJECT ADDRESS <br /> sk�� �'e�� FsrM-r� <br /> Owoer MailAddmss City SIa1c/Zip Phone <br /> k�a✓Iir•�- /�iNl4 GoUNDZ <br /> Tenant MailAddress City Slalel2ip L �nc �S �O <br /> 4S ��o— <br /> ��izv+n47F���%G �0 3ox Zqr� E�J� �,<.c4 (�Nf}�,zS-zsz�i4., <br /> EleclricalCoNractor MailAddress City Slale2�p Phonc <br /> �v4 n � f"e Z83GC, O2`�'q� <br /> Slate License Number(required) Ciry of Eveielt Business License Number(required) <br /> oa <br /> �'�s r�.,���T <br /> yoa <br /> Proposed Use of Dwldin9 CoNract Price ol Woik i <br /> Square Poolage(If residential new conslruction,remodet or addilion) Cvntacl PersonlContacl Numbed[mail <br /> Number ol devices(II low voltage) <br /> Description of Work to E3e Done: �Oo% %O� L�N�T li2 L�,7 f� <br /> FEE --- <br /> q �n <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 � / <br /> i hereby cer(ily 1l�al l lrave mad and exarnined fhis applicalion and knmv(he same lo Le 6ue and .—.__ <br /> r,onecl. Allprovisions oUaws and ortiinances goveming fhis type ol w.ork�vill be complefeJ <br /> uficthcr specilied herein or noL The�ranlmg o/�pennif docs nol pmsumc fo�ive aud�ority fo p[RMITIt <br /> violafe or cancel fhe pmvisions ol any olherslale orlocallaw m,gulating consfrucfion or Ihr, r I���I�� <br /> pedommnce ol construcfion. Th.if I arn aulhorited by IOe owner o!this properfy fo PeAonn Ihe C I <br /> work lor whicfi application is madc and 1 eonq�ly�vifh llir, SW(e Conlracfnrs La�v 78 27 RCW�and ___ <br /> 296.200 WAC. <br /> ���c�'�- G - 11-is --- <br /> Signalurc Dalc <br /> rnerucerr,�nia . ___. __ . _ . _ __._ <br />