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-�,iii:; _�i/'�I�I ,ii!pii jQ:IJQ .".!1 „ree,�v;ood lieating F�.:•'. ?1G. 'Ij�j �,n' ;�i1; i'. iilJl/il�l� <br />ELECTRICAL PERMI�' APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 C[DAR STREEf, EVERETT, WA 9�201 <br />425-257-B&10 - FAX 425 257-SE357 — w�,w�.everethva.gov <br />�110 SE EV��r� /��Cc�� l/�C1U ��0� <br />PROJECTADDRE55 <br />! Fr�k DCrvfion .�_ <br />IOwnor h7yl AC�'resy Ciry SlotelZp Pnone <br />�rik DZvt�� �i�� Cvc'�.t� Mc�ll Wi, �l�e�ct� V�/-I 9u208 i`�25,L�7o33� <br />iT�f13f1t � P.1ailAadres5 Ciry StatrJZ�p Pnone <br />—SV�au1i./��hhlrc�-r�c P�25 S.Sh��n, SF S� <br />ieCtrCelConVactor n;ailAnpmss Ciry <br />Asyo�yw�ls,�,�n <br />� S;ate Lice•tse Number (req�lredj <br />� S��n�l ��� �ch � h�� - TI, <br />; Proposed Use of �uildinp <br />%7i4� <br />Square Footayu (If rc�;idontial new construcLon, remodel or �dCiticn) <br />i n ic, <br />j NCmCor Gi JeviceS (If IOw volt3ge) <br />98���+- �z�ha3 v Zs <br />Sta!e2f0 Phcne <br />Clry of E�erett Busmces L.:ense N�.,mber (required) <br />3b 2�2 <br />ConL�ct Pncc of Work <br />Scbf+- I-�-c I I�2c�� I�3 zs2�— <br />Gonlact Person!Contact NumBenEmad <br />Doscr:Diion of Wonc to �e Dnnc: IO`J� �y� 17 S( I hl�� � 1� � ���_� /�/ C 1 ��' (� �"� �n r <br />SC�nC��/yLCl1 r7 �Ci�-%l�nr ��j ?- 'O i�-j �< i f rf1,�n n���-���,� �'LOf� 'ICU <br />CITY OF EVERETT LOCAL SALES 7AX COUE i5 31U5 <br />1 hereby cedrly thu: I have raad and aa�ammotl tfus applicafion end kno��v 2he sume fo 6o frue and <br />coirect. All provisions of laws and adrnances floveming this typo ol v;ork will Do complefed <br />whr.ther speci6ed ho�a�n or nct. Tho grn(ing ut a pennit does not p�esum�, m yivo aufhon�y to <br />viclate or canc^I thc pmvisions o/any olhor s(afo orlocallaw iegulaGng consfn�c6on w �hu <br />p��lormanco ol constr�clion. 7hal 1 am aufhomed by �he owner of mi5 properiy (o porlorm the <br />�-rork !or u-hlch applicaGon is mado and ! comply wiN the Stafe Con�ractors Law 7 t3.27 RGV✓ antl <br />29o.2DQ lhSi.�. <br />�io� <br />IrC�i£E�Crv^acoi� <br />FEE <br />� 12l a �� <br />P[RMIT# <br />El�og-21(� <br />