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r <br /> � _ �Id.� �um.rl" *._$1-001 - 013 _ <br /> . - -- I <br /> __ <br /> I -- - I <br /> ELECTRIC�L F'FRMI�' APPLICATION I <br /> CITY OF E��ERE'Fl; PERMiT SERVICES � <br /> 3200 CEDAR STR=ET, EV6RETT, WA 98201 �� � ' <br /> I •, _ _gg57 _�,,w.everettwa.ory ` <br /> � 425-757-8fi10 - FAX 4,_5 257 I <br /> IAPPLICATIONS ARE ACCEPTGD FROM 8 AM TO 4 PM <br /> ,Oc1p �ve.�,-l{ Alal� l�a�. �#�5 cvt�c-�}. WFt 981oa <br /> PROJECT ADDRESS I <br /> I <br /> — I <br /> — SWlel7�p PhonC � <br /> (dail AaUress ���>� - <br /> I Owner � � <br /> � �' �.�� 9rf�o8 <br /> x�9P,,-e l000 cvcr�� Mell Wa�'L—305 - s�,�i����i� rno�e � <br /> Tr.nanl <br /> rea�i ndares: cny <br /> 98i33 ��� �-y i�' <br /> AXM �1.�C71ZIG IOooz �v�eo� A�r� N. #3fo -';IISS S��t �� Piione <br /> c�iy sia�erz�� <br /> EleclricalCoNraclOr MailAdtlress <br /> � �� lop . Oo <br /> ftiSM �L$L 91 g (:� ������ Cont�ac���rice of wo�k <br /> Stalc License Number /_, <br /> ANDY I�iTst��t5��9=-y9�j�' <br /> i _Q�CP Conlnct Percon (Pl;m Review) � <br /> Proposed Use of 6uJdmg <br /> � -YChl,o _�I ,��C oCa SIr+ITG�� AC Ar�OC _ <br /> Description of Work to De Oone. <br /> O�.i.� lC� 1\t IoCa}� fxfS� n�.� 1� In�— - <br /> � <br /> NOTE: W�IRN R�CGWAI'3 MEC OR AC CAl3 QUIRE�TO <br /> FEE <br /> CITY OF EVFRETT LOCAL SALES TAX CO�E IS 3705 �- - <br /> I1 hereby ce�fily Ihnl 1 hnvr. m•�d.�nd examined fltis applir.eGon and know Iho samo fu bo lni��and <br /> Icnnr.cl. /llf p�owsmns n/Imvs and ordinanr.es govmnu�,ry this(yPe opl�•�ak�viU Ue completecl <br /> v'ol:ifc nr canc�l�f!o�ravsi��vs�n/�ny othcr�^�t�ir, or Incal l�v rr.9ulnfEig con'�r9cf o r�or�thcy lo �' ��� ! �� <br /> I �� <br /> Ipr,dormanr.c olr.nnsfiur.lion. Th��f 1 mn aulho�izr,d by the ownr.rolthis proped}'lo podonn(hc <br /> �vo�k!ar�vhir.h ni�plir.,�fion r�nradn anr!1 comply wdh Ihe Sfnfe Can!raclors La�v 78 27 RCW and <br /> 29fi 200 LNAC. <br /> I py/c+3 Jlo <br /> I, � Uat^ I <br /> Si9n.tNre <br /> I <br /> I .. . _. .. . . . --_'_____——_— <br />