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To P�rmrt Services Page 2 0� 2 2015�02-12 22 37 2A (GMT) <br />... . .. .. - • . � � . �. - . � .- � - ��• <br />�253265026B From�. [r.c Otsen <br />ELECTIRiCAI. PERMIT APPLICATION <br />CITY OF EV'ERETT PERN!IT SERVICl=S <br />3200 CEDAR STREET, FVERETT, WA 98201 <br />4Z5-257-8810 - FAX 425-257 8857 -�wnr� everettwa.org �—� 3- � 5 <br />EiSo�-o`i� <br />��,� �S E ��er�-1-�- „�'l�;I � UJ�t�� , L—��EF'�- <br />PROJECLADDRESS —�- <br />Owner <br />r,tsi nddrass � - � <br />Cry <br />Sta;e!ZiP � _ . . � Pnone <br />Tenant � ' I.1��I Ad]ress � � 'City � ' � / StalMZip- - - � � ?hone� <br />( .�I��i'(� l��r{.�{��C� �S�S ��t-�d:>>h�En/1 /�-�Y..ti� �1��VT/1��-�il�%�� "l��i��..� <br />EleCtnCal ConVaCtor � _ . M11aJ Atld�ess . � � - Cry � � Stule!Zip � _ � Phone <br />�c. U�ccn��.:i��P�=_ <br />.StataLicenseNumber{required) � �- � - � � <br />(�� t t rr1.,n t <br />Proposud Usa of Bwitlmg - . � . , . . <br />SQuare Foota9e Qf residenual new consVucuon, rempdel or.add�tionJ � <br />-C�ry of Everett Business Cicense NumGer (reqwred) � <br />a 5; U �\. CJC.1 <br />�CcntraclPrice�ofWork � <br />�i� S.Y `!� (3t rC,�'1(�c.'� . <br />�;Sl,�-yi_To'.-l`105� I�„5+2:��1�Ol.3cnc(tc.Fr:�_� <br />. �Con�act PerSONCon aCt Num EdEm� il �. � <br />' Numbei of devices pt law voltage)� � � � � � - � � �. . <br />I UescnptioiiolWorkroBe�one�. � �diS-i��-�� \:�/j�i-;.�C� c+n � i/'4\SG, �UvJ�f(� � .. . <br />—T <br />,I ,_. . . . . . . . . - . . . <br />I- - . . . . � � . . . . . <br />I. . � � � � � �. .�.._. . . . . . . . <br />i FEE " <br />� CITY OF EVERETT LOCAL SALES TAJC CODE IS 3105 � � � � ��� ��� <br />I! heroby cerhly (haf I ha,o road.anU oxamrn�d Ih�s yppl�cauon andknpiv fho samo�fo bo frue and <br />con�cf. All piovisicns ol�laws and ord�nances govemm� Ihis typs o/�t�ork w;ll be comnlefed � <br />:vhother specifiaU heierii or nol. The yranting of a pe�mR does ncf pwsume !o �ivo aullionry lo pERMIT�' �� - <br />violate or carr[ebthe provis�ons o(any othor sfa7o o[ IGcal la�t• mgula:ing consfnlc(ion or tnp � � � �7 � <br />perlomtanCo.o( cons(rutLon. �Thot 1 anr autho�zod�by tho �wnoco( Ih/s prnporfy!o perlorm thn. � E+�U.� -. U"1 � <br />�vork lo� which apphcaiion is made�flnd I complywifh7ho Slato Coafractors Lav: 18.27 RCWand �- � <br />296.200 WAC. . . . . . . . . - . . � <br />.,..z� a . <br />J 43naturo � . � . . Dot - . . . . . . . <br />. FEl'IScCCBOfi^JII � . . . . . . . . <br />37 <br />