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� � <br /> E�.ECTR9��►� PERII�iT' APPLBCA�9�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br /> II 3 O 2 ����'� �v �;��/p� � <br /> PROJECTADDRESS <br /> �M ���(� !/� 02 �v�r,�e,� � ��� 9�Zo�i �) �0?6�^0 <br /> Ownef MailAddress City Slale/Zip Phone <br /> TenaM MailAddress City Slale/Zip Phane <br /> �'���i� �C�^ 1n� e1MlC ��iy6 i�yP« ,��.I�f 7� �' y�0 /"/� <br /> EleclricalCon�raclo� MailAddress Gty Sta:elZip Phone <br /> �;Q ��..�. �� � � � 6 � �_ <br /> Slale License Number Contract Price of Wo�k <br /> � Q �.D 61'9O K.-1 - <br /> Proposed Use of Building Contact Person (Plan Review) <br /> Square Foolage(If residential new conslruction, remodel or addilion) <br /> Num6er of devices(If low vollage) <br /> Description of Work to Be Done: a�� C'��� � �� �C�� <br /> Gwt Q�l��� � �-v1.� C'.u/�C� /' G' C��P� <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 I q 7� S v <br /> 1 hereby certily(hat I have read and examined fhis application and know fhe same(o be true and <br /> coriecf. All provisions o/laws and ordinances goveming this lypa o/work wi116e complefed <br /> whetherspecilied herein ornof. The g nfing ol a permit does not presume fo give au�horify to pERMIT# <br /> violafeorcanceltheprovisionso/a fherslateorlocallaw�egulafingcons(ructionarthe � � , /��,D �y� <br /> peAormance o/con ' n. 1 am aufhorized by fhe owner ol this propeRy fo peAorm the ��r' 6 <br /> work lar whic plicafio ' ade and 1 comply wifh fhe State Confractors Law 18.27 RCW and <br /> 296.200 C. <br /> �'I ���I Cl <br /> Sign re Dale <br />