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f98/12/2015 10:25 142�i"7751960 <br />� <br />ACi�IVE EIJGIFIEERI�JG <br />� <br />ELEGTRICAL PERMlT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVER[TT, WA 98201 <br />425257-8810 - FAX 425-257-8857 - vnvw.everettwa.gov <br />�,3 LcoNA» ��- <br />PROJECT AODRE55 <br />PAGE �1i01 <br />� -�3-�Jt' <br />� IS��-D�� <br />'C�� gc-a �5�I3 ou �.r� O� ��ce.� W� �Fs�o1 `�i zaZ 1��4 <br />Cwner rdaa Acldrnrs Giry Sw�afZ{p Pro�e <br />lenant <br />r���i ndamss <br />Gry <br />SlalalZlp Pn�no <br />L^�-T�`'� GtiltltvccV.iJ,r lt�br���� � S� �i...� l-�.Iw�.rY�J l.�A GSSU3(„ �.JS�•ilb rli i <br />Elet�rical Convactor Mail Atl0�H66 C�ry S�aia2�p Phane <br />(a,c<��� ''� o�F. Y�1S <br />Siate Liconse Number (reQuifM) <br />�� <br />ProD�sud Use of Building <br />Squaro Fpolage (II wsidenlial new tonstruttlon, remotlel or adJit�pn) <br />Number of devlces Qf low voltagc) <br />u � t� <br />Ci1y et Evereri Buslress Li�ense Numbar (required) <br />� S CTi _ � <br />Canlrnct PriCO ot 1M1'orY. <br />nesr.ription ol Work to Bc Oone: �ai.,��_C�l�,-.�u� .. <br />CITY OF FVERETT LOCAL SALES TAX GO�E IS 3105 <br />1 hr,reBy cert+ly �hnf I havp road and e�•aminad7his appllcn!!on nnd know fho sam� fo 6e true and <br />co�i�et AIlryovisiuns ollaws �nAcrdlnoncos govommg Ihis typei o� wnik will be compleletl <br />whafher sper,lfied hrroln or not. �nu grdntiny o� a n�rmit dnes nof presume t� y�ve autnwiry rc, <br />v�oivfo or r.ancal fhn provisinns of ony o7her 31ate o� I�col Ww reyulafing conskur.fion or the <br />perfnrmonee o! eonsvuefion Thaf � am auUir.rned by fhr. owner o� fhis p/oAeNy Iu pvrlerm the+ <br />wo.ic lar wRich appllcoflo» is roado ond 1 comply with tho Slafc Cnnfrotfor^ L�w 18.27 RCW anJ <br />296.200 WAC. <br />_ d��;� —____ �J,� I , � _ <br />Slgnalure UaU <br />��e �.�;,� onp�.�n i. <br />� <br />FFE <br />���o�� <br />PERM[Tu <br />E I�(�d�D��' <br />