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Dec 03 14 1123a Ivs 2538919232 P � <br /> � • ---- <br /> ELECTRIG�iL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT: WA 98201 <br /> 47.5-257-8810 - FAX425-257-8857- www.everethva.org <br /> �g�viz -oa3 <br /> � � i ��, F.��� ,��z �; �a :u�� U�i-is <br /> PROJECT ADDRESS <br /> Ownet Mal nddross Ci1y SlateJZ�p Fltono <br /> !.�'— � ���5 <br /> ��FrcC n�Pc ; �`, S �`' <br /> Ten�Ol MaJ Address City SIaldZip Phnne <br /> / c-. 7• i I _ � v,✓- ��� (,.�.;. vY3`ii l��s'151yIj I <br /> L� i 1..�.� M ' �r � �nrs� �l�a I C-f G� 5� Gf E f-s "1� <br /> Eieclrical Contractor Mm��ddross Ci,y Slaco2�p Phonc I <br /> � ��SZ.��- I <br /> ;��� �„��<�.s>oi <br /> State License NumSer(reawred) City of Everett Business License IVumLer(required) <br /> Proposed Use oBuJding Con:ract Price of Work <br /> /1'13F�i� �i�i(J Z�3 �SIUj'`J <br /> Square Pootage{If resitlential new construclion, 2model or atldition) Contact PersonlContaci �umber/Emad <br /> NI�..=1L�VS�✓�/�:..L<.^'t ', <br /> � <br /> /� t,c .`+r.'•-.S <br /> Number of devices Qf low wllage) <br /> Descnption ot P/orY,m Be Done: /� c �:-w c '= l' J 1 / �1�, � ���.�„��S /��f„ y�; (,.�t L' c' 71C c' <br /> f�l/YZ IS ili CG'+.LN 6���- � <br /> FEE `I��3.� <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 5105 •� ���7u ` <br /> !hereby ccrtity fhaf I have road and examined Ilus applicafion and know fhe samn to be buc and <br /> correcL All p�owsions ollaws anU ortlinancos govoming this ry�po o(work wdl bo compfeled <br /> �rhefher spea(rcd horein or noL The granting ol a pem�if does not presume!o give autbonly(o PERMif# <br /> violaro or cancel 7ho provisions ol any afhor s(ate orlocaf lavi rogulafing wnstrucGon or fhc � � � 7 6 3 <br /> pvrformance ol consfructioo. Thaf 1 am autho�ized by fhe owner o/this proporty to perlormlhe � , �[�'- � <br /> worh!or which applicaGon is made and!comply wi�h the Stale Contrac(ors Law 7827 RCN✓and <br /> 296.200 WAC. <br /> %/'�L��--�/�-.- IG���`/ <br /> � " Slgnaluro �' Date <br /> Fe visen ox�r.mr: <br />