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p4/26/2007 21:44 1425775196� <br />ACTIVE ENGIIdEERING <br />i . <br />ELECTRICA� PERM <br />CITY OF EVERETT P <br />3200 CEDAR STRCET, F <br />425-257-8E310 - FAX 425-257 <br />�t lo a G E' v e� ,� <br />PROJECT ADDRESS <br />Uvner <br />Moll nddreas <br />APPLICATION <br />�IT SERVICES <br />TT, WA 98201 <br />— www.everettwa.org <br />Stator p <br />PAGE Oi/O1 <br />ga���� <br />�1�0�-d�S <br />�S <br />PhonO <br />�7�pr Lra1.;,.0 `�(.�S C-�.,rti.-.�.r�tJ$� Evr,lu� l,�((k RFr7.�4 <br />7ewnt MailAddmcr.� Clly� Styte/Lp Phanc <br />Qc�'- EnS:,,cr�;,, (c(,8s Loo'"'' S� sw ' <br />4 L7n I�n�c� LS(� 4FA3� NaJ•��bll�7 <br />EleCtr'�al ContraCtOf �dad Address City! SiotdZip Phono <br />i <br />i�r_�,,� �` aFrss+,nS <br />Sfate �icense Number (required) — <br />ProposAd Usc of Bulding <br />Squam FooWge (I( residentia� new construcGon, remodel or addllion) <br />Nurnber of dwvices (If lowvollagn) <br />nescriplion Of Work to BC fJonp; <br />:r: <br />� D 7� 7i�g <br />City of Evemtl Business Ltcense Numbcr (required) <br />.`� � OC/.� <br />Contract Prlco of Work <br />; W a��. ��1r�c�n'I �6 o a_k 3 a9&'1 <br />i C�nlar.t Person/Conlact NumbedEmail <br />0. <br />CITY OF EVERETT LOCAL 3ALES TAX CODE 13 J105 i <br />I hcroAy �rorillylhnt 1 h�vc nead and exam/ncd fhis apolienlion and know fhe s�mc fo be tme nnd <br />corrwcl. �ll provis�ons ollaws nnd oro'innncas goveming thia type of wvik will�be comp/eted <br />wholher spocified homin or nol. Thc �ran(mq of a parmif dor+s nof prusume M giw authnny (o <br />violafr� or enncr+! the provisronn ther slpfe of local /ow regulafing cons(}utG'on or Ihe <br />pedo�m�nce ol co sWcti . That l ar authonmd Gy thr owner o!lhis propr�(Y to pedorm the <br />work !or whi a lrcal' (s mode d! r,om y with tho S(ofe Confmctors �aW 9R.27 RCV✓ anr7 <br />?96� W . �� I . <br />,�_/ <br />nrvrcco ono�, x� �. <br />FEE <br />� �J.'�j C7d <br />PERMITH <br />El�(��-�g� <br />i � <br />�� I 1i s <br />