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— — —�----- -- ----� - -� <br /> EL�ECTRICAL PERMI� �4PPLOCATIOf� , <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 C[DAR 5TR[[T, EVERETT, WA 9E201 <br /> 425-257-8810 - FAX 425-257-8857—v�v�nv.everetivaa.org <br /> b/s /�--a 1� <br /> �o �a� _i5 <br /> 35�c� �Ib,,� A�� <br /> PROJECT ADDRESS <br /> �- <br /> Gr�� L /�S /��nh� <br /> Owner MailAddress City StatNZip Phone <br /> �nvii-{at,0 Vbe,�lL.00�i�J- (�LfHYcIL FVed`�-W- W !a 353�7 C'� Ibh /-' rtJ <br /> Tenant � hlail Address City StaiNT_ip Phone <br /> j�a' � � 1��+.;c Q.o f1a x 3�rz_: ��'.,1,.., �f� �'�OyZ <br /> �✓� css <br /> EleclricalCoMrattof MailAddress C;ty Slale2ip Phane <br /> �A2'1�Lf c �BS�M� � S�(� 3c� <br /> State License Numher(required) Cily�i 8usiness License Number(required) <br /> 1 I i <br /> �Gi`� 1N LO� `� <br /> Proposed Usc I Building Conlract Pricc of Work <br /> '�L7(� �740 ��)Co5 - Se.a.� - <br /> Square Footage(If residenlial new construction,remodel ur addition) Conlaci Person/Contact Number/Email <br /> -- �' <br /> Number of devices(If to�v vollage) <br /> l�1 I1 � <br /> Description of Work fo Be Done: -_}_�"5 "�"` �� y �� �1�+S �� ���I�+� n� <br /> FE[ — - <br /> CITY OF EVERETT LOCAL SALES TAX COD[IS 3105 � O � <br /> I he�ohy ccrfi/y ffiaf I havc read and examincd this applicafion and knotv the same fo Ge(rue and _ _ _ <br /> correct. �1(I prov�sions of laws and ordinances goveming fliis type ol worlr�vil/be complefed - <br /> u�hetlmrspeci�ed herein ornoL The 9ranting o/a pemiit does not presume to give aufhority lo PERMI"f# <br /> viola(e or cancel fhe provisions o/any ofher s�afe orlocal lmv regulafing conslrucfion orlhe r <br /> perfonnance o! onslruclion. That 1 am authonzed bylhe owner o/this properiy!o perfomi Ihe C �5 (Q,r 2� g <br /> w.ork for�vhic applica )r/,�S de and l compty wilh tbe Stafe Contracfors Law 18.27 RCbV and <br /> 296200:1NA ! / //� <br /> � � <br /> ' .,�i� � �� �0 � �°I - 7S <br /> SignaWre Date <br /> �aFvrsenasnscma --- - --- --_ <br /> I� <br />