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Polarily Electric Inc. <br />• <br />206-546-3509 p 1 <br />� <br />ELECTRtCAL PEi2MIT �PPLiC/�TION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257•8857 — vnv�v.everettv+a.org <br />? 5 I 0 �.�;Ak.� T,R <br />PROJECT ADDRESS <br />.G'�'� <br />3 — lg—aY <br />� �ti}�U�' 2S l'J jj�1dMD D� 7.�?C1Q.�i[i l�A 9�� �L•?69 - <br />�, O�rmer A�a:l qCdres, G7y StatelZip Phone <br />Tenanl <br />L1a11 Address <br />Ciry <br />S ate!Zip <br />Phone <br />�f�2tY �L�.CfR_IC ,�,D, (�X (�Q�Z SklQ�6C}3: w,1 �i� 1'SS 2D� ��iG-353h <br />Elxlnw;ConVaclor �dalAdtlrcss Qly Su�ta2iV Ptone <br />�OW+R EZ 9 22 �o <br />Staie Li�nse Nuraher <br />�i��- <br />Propased Use o1 <br />l9'7� <br />Spuare Foolage Qf residential na.v conslruclion, romodel or aAdltion) <br />Number of devices (It low vcltage) <br />26� <br />Conlract Price of Work <br />h�At� HPCkt;(z zo� •�86-762q <br />Conlact Person (Plan Review) <br />Description of wo�k to ee Done ADD i�AMY S�B �`l.�� d ADO �3� A�Pt2WJlX., QRC�TS�_�.A�i, ��_ _ <br />OVIIP�CS, Wi(aC LL1� N�w Sv�1L"iti,N��� wt� 7) N� �+tt£� wtM1i�pDOwhcR bF fbRi��n�:('� <br />CITY OF EVERETT IOCAL SA�ES TAX CODE iS 3105 <br />1 hemby rortify tha! I ha�e read ontl oxamined lhis applica(ron antl kne.v (he samo !o be liue and <br />cormcf. Afl provisions ol laws and ortiinancos goveming this f}T�e o(wor'� will be compleled <br />whotherspoci�ed hemin orno(. TAe granfmg o(e pomiif does not pmsume [o give au(honty to <br />viol;�fe or cance!!he provisions ol any ofhe� s!a(e or local law �egulofing tonsWcGon orthe <br />pedortnance ol cons(rvcGon. That! am authorized by fhe a�mer o/lhis propoAy fo perform fhe <br />roak !or ivhich app6cation is mauo and 1 cempry wifh Uie S(ofe Contradors Ww 7 B.27 RC W and <br />296200 WAC. <br />13-I`J <br />r,cws=o a22e� <br />FEE � <br />��� <br />PERhtIT# <br />E14�3- 0(�� <br />