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� <br />`, <br />J <br />E�ECTROCAL PER6VIIT APP�.ICA,TIGN <br />CITY OF EVER�ETT PERMIT SERVICES <br />3200 CEDAR S'i REET, EVERETT, WA 98201 <br />425-257-8810 , - FAX 425-257-8857 — ��wrN.everettwa.org <br />i�o� L•✓G,2c�rr,� <br />PROJECT ADDRESS <br />I Ovmer <br />AZf1 Yo� <br />t•a�.l nddress <br />/ L!/ElLC�tcVl�`/ <br />t.tad Atlares, <br />!l1 <br />Gty <br />Gry <br />� �J � / ! '— <br />SIaICIZip Phone <br />/�`�J I ../ <br />Stale2�p Fncnc <br />j a/S/ �s�6G i?,:An✓r..EOf __j,'_Fta,r�eHAw.t Lu��47-.zs 3Go-/•7F71� ' <br />EIBCtriC�i Co�1�dd0� '•1ad ACd�ess C�ty Stale/Zip Fnnne <br />Si�,��� �r syc �,� _ <br />S;ate License Number (reqwred) <br />R�-r-n i�, <br />Preaosed Usc of F3uild�ng <br />Square Foolage Qf res�tlential ncv+ construd�.on, remo0cl or addiLon) <br />I Numhcr o( dev�ces (If lo•.v voltage) <br />Descnption of Wor'a to Be Done in� SSA <<- 'r�� <br />CITY CF EVERETT LOCPL SALES TAX CODE IS3105 <br />Gty of EvereIl Qusiness License Number (repwred) <br />{s�b <br />Contracl Pnce o"+"✓ork <br />iAr/KC L/'�'EGf.INi�/S/GJ�SPr-�S <br />3GG'L'7/'7/CS I;'/,�'p,f�i i�l�1rP/nCP..a. <br />Cont2ct Persor!Con'.acl N�i mbed m3�, <br />l�.� l, L S 1(.' �✓S <br />1 hereby certdy that 1 have read and examined fhis npplicntron ana know fhe same fo be Vue and <br />coned. All Rrovisions ol fa�vs and ordinonces goveming Ihis fype ol work wJl Ge complefed <br />whether spea�ed here�n or not. The �ranting ol a �es not presume to give authoriry ta <br />violafe or cance! fhe provisions ol any other s orlocal v regulating consfrucfron or fhe <br />performance ol consVucGon at am a�orized by t ownei ol fhis propeny to pedorm the <br />w�o�k lor which applicafio is rnad an comply wr e Slale Confracfors Law 78.27 RCW and <br />296.200 WAC. <br />�����o� � <br />�_ ..SPD .° d:Fau <br />Irr:E <br />l _ � D°� <br />Praratr� <br />E15o� - D7� <br />