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� <br />L� <br />ELE��'Ro��41L P�RNiO� �.��LOCA�I�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 S._,p S—I s <br />�b i SE F�,,�( v�� (( („�� M- ��f� v <br />PROJECTADDRESS <br />Owner <br />Tenant <br />Eledrical <br />M�. c`�O I D <br />Mail Address <br />r �v� �IOc7 <br />ail Address <br />viS `�abl <br />Ma'�� ;Jdress <br />1�F�N�l c� 1� (� �� <br />Slate License Number (required) <br />� �S p -rj .-� 2 � <br />�= �� N �, b�lle��.�, � n ��ao� <br />Cily StafelZip <br />�� � enrPi� 1Ma 1( t.c�� ��e�s` ��+�' H `3 <br />Ciry StalelZip . <br />� �JeJ�v `��� ���) � CI� (' L(�S' <br />Si��a `�SI��I <br />Pro sed se o( Building <br />a� s� � <br />Square Foolage ( residen�ial new conslruction, remodel or addition) <br />� <br />Number of devices (II Icw vollage) <br />Descriplion ot Work to Be Done: 1 Y'c� �I � <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />City <br />��t <br />�, ; � <br />Phonc <br />��� <br />Phone <br />- SDI- �� <br />Slate/Zip Phone <br />�� Co�4 � <br />Cily of Everell Business License Number (required) <br />a�� -- <br />CoNract Price of N/ork <br />�=�5� <br />Conla Person/Conlact Numbed[mail <br />�I�S - 35 3� �I 1�3 <br />j��-Y @ ��.�Q�e������ <br />i <br />1 hereby ceAi(y thaf I have rcad and examined this application and knowlhe same to 6e true and <br />coner.L NI provisions of laws and ordinances goveming this (ype ol wodc will be complefed <br />whetHcr specilied herein ornoL The granfing o(a permit does not presume fo give aulhonty to <br />vio/afe orcancel fhe provisions o(any ofherslate or/ocal law iegulaGnr� construclion or the <br />peilomiancc oI cons(rucfion. Thal I am aulhorized by (he owner o/ Ihis property fo perform thr, <br />U�ork lor which applica(ion is made and 1 cornpty wilh IAe Sfale Con(ractors Law 1827 RCW and <br />296200 WAC. r� , <br />� <br />f-FE <br />✓V� <br />PERMITJt <br />EI5o5- <br />