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� • <br /> � --- — - — --- — -- -- <br /> �LECTRI�AL ��Rf�19T /����.��A°�9�iV <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVEP.ETT, �P/A 98201 <br /> 425-257-8810 - FAX 425-257-8857 — wv✓w.everettwa.org �j�� --)� <br /> C—� r uo3 .—, ��j <br /> `�8155 EUERGREG�� WA`/ EV�CZEt�[ WA 93Z6� <br /> PRO.IECT ADDRESS <br /> I�ARY��(ildy NIAX 2411 I GI a� ave �,1F�o� 4V� ��9ts��5�1494 <br /> O�aner t:lailAddress City SlatclZi� Phone <br /> I/ar���� <br /> Tenani MailAddress Cdy State2ip Phone <br /> _l�l)_k��C�Ri� i �r, t�� �ox i�.�_E�e��kE--�L�'��Z13 (yzsl °�23 -u��no <br /> EleciricalCon,ractor PAa�lAddress Cily Stale/Zip Phone <br /> El'_NDELED �t3RN`F T � M �{500�� <br /> Stale License Number Conlracl Ptice o(LVork <br /> Prcposed Us� e,�o B�ng Contact Person (Plan Review) <br /> Square Foofage(If residential new construction, remodel or addition) <br /> Number o(devices (If low vollage) <br /> Descriplion of Work lo Be Done: RN�nr��.e eX�C�1Y1[4_—��l�l(I��d <br /> V1f'h :�WI(� e' � S�� <br /> �l � v <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 I�—j 5D <br /> � <br /> I hereby certily that!have read and examined this applicalion and know(he same(o be true and <br /> correc(. All provisions ollaivs and a�dinances goveming fhis lype of��ork wtll be complefed <br /> n�hefhe�specilied herein o�ncL The g�an(ing o(a permit does nol presome(o give au(horify(o pERM1T?I <br /> violafe o�cance/Ihe provisions o/any o7her s(a(e or local la�v regulaliny consl�ucfion o�fl re <br /> peAormance oI conshuclion. That!am aulhonzed by(he o�vner of Ihis piopeRy(o perlorm(he E I �D3 J �?j <br /> �vork fo�v�hich applicafion is made and i compty wi(h Ihe Sfafe Conf�aclors Law 18.27 RCW and <br /> 296.200 W� <br /> ` ,� �, _ �_�_�y <br /> Signalure Date <br />