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OS/?1/201� ll::;i F�S J2595J899d Eversreen Securlt� � 002 <br />• � <br />EL�CTRICAL PERMIT APPLIC�4TION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREE7, EVERE7T, WA 98201 <br />425-257-pp10 - FAX 425-257-8857—www.everettwa.org <br />I Z� S W�-v2�-� tila.(, I c,�.-�,-I�l � <br />PROJECT AL�DRESS <br />OwnOr <br />M�il AdCress <br />121� <br />City <br />i�� � f-g'u f <br />Pho�e <br />— 54��2 ct5 �'�2,� — <br />.T0n311t .U.�il MJmss Cily Stotu?ip PBone <br />ACdreSs <br />C-v�.R�s �I I al-"� <br />Srate Ucense Number <br />'�_rr1eX c.�.pvF <br />Proposed Use o( 6uilding <br />�lOr--� � <br />c�ty <br />Squnre Footapn (If resiCerttial new wnsVuction, remodCl of ndtlitio0) <br />� <br />Number of tle�ces (If low valtage) <br />#� �'1g2A3 (1-425�3'kFs- <br />State2lp Phune <br />� �3. (� <br />Contracl Prico of Work <br />�JrQ.I'1 �'1�s,rr� <br />Conl'act Person (Plan Review� <br />De:;criptionofWorkloOeDane: _�.�(J.�.�.�Qi'� 1.t�1 ��i- l.livl� v�\T�—� W�V <br />cnn�..iP a^C1 �'�. %v� 1 l�i"T�•3�- ��.t.. � R, � s I.n -�— <br />C� AXYtRJrLLS ''F Z �U'-�U�`-� c�-r � �Q �'Oil(�.�5 . <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />i here6y crR�ty that i havc+ read and axamin�d fhis application and Know tlra samv to be (rur and <br />conect AIf provisions ol lews ond orclinenc:es goveminp 7his type o/ woMr vdll be complefed <br />whciher specified beivin or noL The gryntrng o/a permi( Joes nof piesume fo give aufhonty (o <br />vrolafo or cancel llio prowsions ol any other alafe or focal low rcgulatinq conehucUon or tho <br />perfortnanee of conslrucfion. Thuf / am uufhadzed Gy fhe owner o( fhis propedy to pedorm the <br />v.-ork for �vh�� i application is msde anA! cornply wifh tho Stato Confractois Law 78.27 RCW anU <br />29G.20p�WAC� <br />S�Z�i l3 <br />REV13E0 ]2d19 <br />FEE <br />SO�oO <br />P[RMIT� <br />E � �JaS- � z�3 <br />