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09/l0/2�14 09:23 14257751qF0 ACTIVE ENGINEERIhIG PAGE O1/�' <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 96207 <br />425-257-8810 - FAX 425-257-8857 — www.everettwo.arg <br />qD� SC � �ece,!� �,Jr�., U�:�-A-,�ro <br />PROJECT ADDRES3 <br />E.mevxc� G�n i18Ws`�l� 569 Sa E�c�ua Wry, A-I`� CVWL7r* 1..��}4k7� 'U<�s4• � <br />Own9r 6}a;l Addrenc C'ry Stn:rlLD Phorc <br />Gvanu) e�*1 RGce��uc� �d'i5ti E�w+'rt' Va�A-��o Ev�en.au l,.�P ik� y� aSY_� <br />Tenant 1.1ai1 Add�C6s C�ty SlatefLip a1m,u <br />�}C.�'�vF er�t:�•t•nn�t. (iltos Zoo'•" 51-s.J Lt�2wavri �0. 9bs:�.. 41S Ti4-41rS <br />ElecMcol Contractor tda:l Addros6 C�ri s�a�o�Ip Phorn <br />�CZIJE'�` O�KMS <br />Stote Licen.ae Number (redulred) <br />Propo,ad Use of FiwlCing <br />Square FooL�ge (H revdenl�al new consWctlon, remodel or aatlition) <br />Number.f drricos QI Irnv vol,age) <br />O�tel.48 <br />City o1 Evereri Business Liconse Numbcr (mQulred) <br />SU. oJ <br />Contrdcl Prlce of Work <br />1-�olli Ga,,.�.-> <br />Contact Porson/CqnWcl Numbed[mnil <br />Oc,crlptlon ot VJork la 60 �onc: eX{-Cv�ol � C; Rcv �T Fp tt. L 1 FS <br />Ct1Y OF EVERETT LOCAL SALE$ TAX CODE IS 3705 <br />1 nereby certfy Ihat I hava �oud and examined fhis nppl�cation ond know the cnmc ro bc tn,e and <br />eorrnet. AI! prpvisions o( lews nnd ordin�nee�s govem�ng this typo of work wil! 6a comp/eMd <br />wholhar speclfred he�oin wnaf. Tlio gn, n�ng ol n pormit da�s not prosumv to 9Ne outhoMylo <br />violote or enncel tl�e provisrons ol ony o0rer stote or laca! law requlaUng construction ar thn <br />paAormanco o�conaWcfion Thaf I am aufhonm0 Dy fAc owncr o1 this pmpe�ty (o peAorm the <br />�rork for which npplica8on is mado end ! comp/y witb tho Slaro Confrectors Cow 18.27 RCV✓ and <br />296.200 WAC. . <br />°i � r <br />FEE <br />%� � <br />P[RM1T# <br />E i �D��-v��O <br />A�FEO �6Mt] �� <br />� <br />