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OSi28/201J 15:19 F.aS a25959899d Eversreen Securlty �002 <br /> ELECTRICAL PERI4�IIT APPLICATION <br /> CITY �F EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 9820� <br /> 425-257-8810 - FAX 425-257-8857—www.everettwa.org <br /> 51CS1 �re.re�rc.o.�l v`� <br /> PROJECT AD�RESS �LS�2SZ•• ?�u l ( <br /> �ib�Q.rlc.e l.P�tgrn2 v�F �I-� 5to7 ��ve.r�srewlw`a� ��l'Re20� _ <br /> Ovmet �doii nddress C;ty State/TJp Phone <br /> -� �i �� <br /> Tenant M�II Adtlte55 Cily S4�!e/ZJp Phone <br /> � p,n .��i�ri�,, �stts `�r�d� �lo1,C--ve+�k�s'R qg2D3��-a � <br /> Elgdrical C Cof M:JI Ad s Cly Stufe2iD PMae <br /> ��l�22���►,11 ��.,a. —T75•� <br /> Stafe Liconsa Number Contract P'ceA of Wnrk <br /> L%]�� ln m�� yi,n � A <br /> c�, o,���� 1:11'(�.�' �, •- nn....nn.l <br /> Proposed Use of Bullding Contaa Peroo (Plan Raview) <br /> Squam Foatoge Qf resiacntial new consWction, remodel or addNon) <br /> � <br /> Number o dCviCes pf low voltage) <br /> Desr.rip8on of Work to Bo Done: Q��,�.1� � � ( � ���' L:e�l/��/rQ-S 'R� <br /> �il� �.s� r�.��.T V �1t���r�1 <br /> FEE <br /> � CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 ��,i1/1 <br /> �J �L/ <br /> I hnrxby certi/y fh�f f hnve reod ond exominoU fhis appl;cation end know fhe sema fo be frue snd <br /> correcL Aq provisions af laws und ordinnncus govoming lhis typo of wo,k will be complefed <br /> whefherspeclfied hereln ornof. Tha g2n6ng of a pertnit does not prosume fo give eufhonty to PERMCf# <br /> vioiateorcancellheprovislonsolanyofhersfafeorrocallnwiegulabhgconstrticUonorfhe � ��OS�� <br /> porfortnanco olconStrUCA'on. That I em outhorizcd Gy the ownero/this prpperfy to perfomr the <br /> work!or which aDP�icafion is mado and I compty with the Sfnfe Confroctors Law 78.27 RCW and <br /> 296.200 WAC. <br /> � � � <br /> SignoNre Dule <br /> RMSDYM�1] <br />