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-- --- ---+-- -- <br /> � ELECTRICAL PERINIIT APPLICATION <br /> CITY OF EVERETT PERiv9iT SERVICES <br /> 3200 CEDAR STREET, EVE4ETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-885? —vwvw.eve�ettwa.org <br /> �� ���1�t�ao� AvE <br /> PROJECT ADDRESS �yZ5���8-SY�,B <br /> JILt'G cSl�lcJ� I'� � � i9r�� /}�/Fi/I�t �/}�i'��/IL�..0 ��/.� q$Z7� <br /> Owne� 1Aa�l Adtlmss Ciy SlatelLp Phone <br /> Tenant Mad Addm55 City Staie/7.ip P�one <br /> ,3-� �L�cTR�C i�Jf. 122 iy3�`��5�,.1 �yN�v���p �A� 98a8-7 �zcL��S zz�z <br /> Electncal Contraaor Man qaaress C�y StaterZ�p Phone <br /> 3�����19�tZT� n� y�f � � <br /> State L�cense Number(reqwred� C�ry ol Everett Busmess License Number(reqwretl) <br /> .5 (d2�t7t ��� = <br /> Proposed Use of Bwlding Contract Pnce of Work <br /> �jj� ✓I7Cc� o�Z �j7'tVc 51tT1}�E <br /> ('zc�) 3m5ZZZ (y25� Ylb�- 59FJ8 <br /> Square Footage p(res�denhal new consWdion, remodel or adddion) �ontecy PersonlContad Number/Emad <br /> Number of dewces(If low vollage) <br /> Description of Work lo Be Done: _ � �S C1�/�/1e-(..� ��� � i✓lq � over heud �Ci�'V i ce (�/{�{- <br /> IU ✓�d M4,��i� � tc '�D a��OW �U� '}�t) Y1L�l'C �u� �d�nq �pu�e� FJ4C�^C �P <br /> _ �n.LlPr L�c.S �tSG„�i✓le� K� G�Ue -�'0 L�2C.��ct.� 1'h�.}-Cr 7�1 I��'L . <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 ^ � , r D <br /> 1 hereGy certdy that I have read and exammetl fhrs apphcahon and know the same fo be lrue and � 'J <br /> co�ect All provisions o/laws and ordinences govemmg fhis type ol work wdl be completed <br /> �vhe(her specified herem or noL The granbng ol a pemrd does not p�esome fo grve aufhonry(o PERMfTJi <br /> v�olafe or cancel the p.ov�srons oI any ofher sfate or local law regula6ng consfruchon or fhe <br /> peAormance ol consfruct�on. That I am nufhonzed by fhe owner ol this property fo perlomr fhe E I G il � _ C� � <br /> work lor which applicabon Is made and 1 comply wdh the State Contractors Law 78 27 RCW and �JV <br /> 296.200 WAC <br /> _���'� 3- 17- IS <br /> �nat�i Datc <br /> FEYISED O6D6?O1J <br />