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. . C " .. . •� _ _ " _ � . ' ' ' . ' _ n :�" � �. <br /> _ � " '� � <br /> _ '_ _ —__'_ -I <br /> ELECTRICAL PERMIT APPLICATION � <br /> CITY OF EVERET7 PERMIT SERVICES I <br /> 320U CEDAR STREET, GVERETT, 1NA 96201 <br /> 4?.5-257-�810 - FAX425-257-6857--vn+nv.everellwa org <br /> �3 /�� -1 ti„l4 . -�„�s�_ i <br /> PROJECT ADDR[55 <br /> Ownef fdntlAtldress C�ly SlalrlZip �hom I <br /> }�l(�o .� �1�' �3 � _ ti����sT_�=�P -��—`��3�3-3���IrJ� <br /> Tenenl �� �'��'�Admess Gry 5tnirJZip Fnone I <br /> I <br /> � 20 F, <br /> l�..y�"�1���--2�3.�_ ,u,.� ,r�«�r�s�� / �-.7�`,� C��,t�7 -��1 6 sF��r, <br /> Elec!dcalContraclor h�a�inaar,,c; c�:y stalcrz�p rr.c�u I <br /> 3 S oc�c � <br /> i3o�r� E.S o2 ���� ' <br /> Slale Li:znee Number Con ci Pdc�of Wo:k � <br /> /�/s���.,��,.,� ,.��[' --- <br /> Proposed Uso of Bui'dir,g -�—" Cenlad Pe:son (Plon Roviow) <br /> Syuare Foclape Qf resldenllol new conslrucliun,wmodul or zddltion) <br /> Nuntber of dovicos Q(low vollagu) <br /> .� / --� �J (� �) <br /> Posenp��on o(bYcikta Br,Uone�. ��_ � �(•.,,3_ rr <�ler _l�:.v `_l�f.�1� f���J='^-- <br /> Lo,��-1---�-�..t��--G.i.i� .__ - �- - <br /> (� <br /> FEE � <br /> CITV'OP @VERLiT LOCAL SALF:3 TAX CUUId IS 3106 L / n Z��'� <br /> LY <br /> I hereDy cr.diP�I�ol I hnve n�aA and oxantinoJ fn�s ayplicellon and know fhe sonto fo be liue ond __ <br /> a,�rrocL �ii provls�ons o/laws and ordlnencos�7ovemmg Ihis typu ef isork�vill0a conrplol:J <br /> wAelher spod(od he�oin ornoL Tho gr�qlino ul u permlf doos nol prosumo fo pi✓e�ufhonry fo 1'CRMITN <br /> i vioia��or cLnr.el lhe provlsions o/any olhor slale orlocallawrc�uls!1nG�cvns(ruchon or fho r"� <br /> p0l10I1pa0Le olCOn5lNcGon. Thal I am aulhnnzBd by fhd GYIIIPIO/(hi5 p�qoe�fy fo pP1f0lr)7 f00 � I�v g - ��� <br /> �tivrklorwhlch eppl,'callon Is mado and I comply�vdh Ihe Slotc Conlrnc;ors Law 7827 HCW and ___ _ <br /> 2D6.20D'J'!AC <br /> ,��i _�-,- S3' ��% <br /> Slgnolure Ualc <br /> fiEl'3 O:Y.'J'IJ <br />