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SEF'-22-2�115 f99� 12 E!ECTF'I-CIT'r 425 6J2 0'193 ?.�il/u? <br /> ��4 <br /> ELECTRICAL PERfVIIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STRG[T, EVERETT, Wn 9a?_o1 <br /> 47.5-257-8f310 - FN( 425-257-8857-www.everetlwa.gov <br /> E �$D`1 _ i7r <br /> /D/2/ ,E✓o4/'�n ltlar� Suilc�� q _zz—�S <br /> PROJ[CT ADDRESS <br /> N/st <br /> Ovmcr IA�iIACdres. Cny St�tc/Zip �'hone <br /> I <br /> i �/uc✓et C�/in�� io��� F���� a/Qy �� E.�e.� w�r 98�y 9as�a��6 <br /> ITC�0f1i ldailAddress � Gly SLiW�p Phone <br /> I .C,(ec�i'i-C'r�.T�' /29iz �+�r���k�Pol �k�L��PD GJft IBoz'!fi �1a.����-�7�q <br /> Electncal ConttFfCtor ldalAd�ress Qry StatdLp Ptrone <br /> ,F1,�C?I�E-//d� �oa� �y3 <br /> Slata Litense Number(requiretl) City of Evcrell Dusiness License Numhcr(required) <br /> �DpG <br /> Proposod Uso o(6uitding Contract Price of Work <br /> ,�2ti riP��kQ" <br /> /auiie�a e./��/-C't�inc. torr� <br /> Syuare Foolage Qf residenGal ncw consVuction,remode�or oddiUon) Conlnct PersonfConlact Number/Emall <br /> Number of d��vices(It low vollage) <br /> Descriplion af VJork lo Bc Done: I�15T4/I SD/J� f',p8� /�i �.'/r�f �p�op/X�� f�s((//,[j/f�j!, <br /> -� F <br /> /o�fj Nl l7i.s�.r�ilec?! ��r�/ CATSE C'a�lz <br /> F�E <br /> CITY OF EVERETT LOCAI SALES T�UC CODE IS 3�0, � �rl � �O <br /> V <br /> I hereby cerfily fhat!bove mad ond examinod fNls application and know thu samo(0 6o Uuu and <br /> wrrccf. Afl provi;ions ollaws and ordinancos govarning fhis lypo of work wrllbe cvmplefed <br /> wdn(ner speafie��,ere:in or nor. The gron�inp o/o permh does nof pmsume to qNe au(honry to P[RM1Tr <br /> violafe or cancel fho provisions of any olhar ste(e or locallow re�ul�tinp consVucfion or the <br /> perlarmnnce ol ronsaucGnn. TAaf I am aufhonzed by(he awne�ol lhis property lo perfo�m fhe E I�jQ R � �� ( <br /> work/or which app��caGon is made and I comply with Ihe Sfate ConVactors Law 18.27 RCiN and <br /> 286.200 WAC. <br /> ���X-��� %a//� <br /> � Siynalum Oalo <br /> f�l�q�e ca//�sie �r %�y�/t - 7��i�'�.�fou� <br /> HEVf5FDL306�011 <br /> TOTRL P.O1 <br />