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i <br />� ELECI�ICAL PERMIT AP ICA �TIOtv <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, V�JA 98201 <br />4'15-257-8810 - FAX 425-257-8857— ��,'t<•:.�-C✓LrL�'� :✓!•_ ��,. ; <br />ei,,,,� ! Lvc�e-4-fo�,s �� cv��Lr{ w:L Jn,' J <br />� 2� �-I �'�DC�� <br />PROJECT ADDRESS <br />� � V�� <br />Owner <br />Ten2n! <br />0 <br />Po P,�� I �j'-i 7 <br />tia�d Ad]ress <br />CiwtN�)J�E V„ �'•'�r"T <br />fl�ail Address <br />Cl 61LcTj <br />C1y <br />City <br />c <br />j,J;; � � G�'� I <br />SlatclZip <br />Slatc/Zip <br />Fhonn <br />Phone <br />''� , I <br />�✓4^.Jb �ai= �L�ZiI�iC; {'C �ioX i�� -;� �•c,nG, � 1,S) lZ 2o�Z. I <br />u � l,c., f Wa,.,,� LJn . I �„ � s �� � <br />, FleclricalContractor ;�;a,IP.ddress Oly Slate4lp Pher,� <br />I <br />i <br />'' Ir.�.�pil��� ��`G�l.�� VZ-`��'� i, <br />' Sta;c .icense i�umber (reqwretl) Q:y ol Everes! 9usiness Licen�c IJumber (required) � <br />' ��c��,��;��.�r .,�25D,°o ' <br />Propcsed Use o( Buildmg ConVact Price of'.'Jork I <br />Square Foolage Q( residenlial nev+construction, remodel or addiGon) <br />� <br />Number of devices (I( low voltage) <br />�S �'.1MI�Z�nJ TSE'�Ho�.;�.;,�c�.,��.:�i�,c.�.�•.�} <br />Contac! PersoNContacf NumberlEmail <br />� DeSC�ip�ion o(lNork to Bc Donc: Cc�SM�L (��(����y SA�� �N � il �l�N'1LL��LICT� G}= l�(.�i� -y � � <br />I <br />i_ �i.q'i11 F�'\Ni � I�l1r.�C-1 K-��)S Z GrvLoa<iTS ,, <br />� — <br />I FEE —� i <br />i qTY OF EVERET7 LOCAL SALES TAX CODE IS 3105 y� � O OO � I <br />9l� / — I � <br />, 1 hereby certily fhaf 1 have read and examineJ (his app6cafion anti kno:� th.e same fo be �rue and J� <br />I correcf. A!I provi;ions olla�vs and adinances governinl th ; type el �:�crk r,dl be cenrple;ed — I <br />!'�vhether;peC�fiBd h��ein or not. The gr�nting ola permit Uoes nof presume (o g;ve authonty fo pFHhjjT�i <br />' violafe or cancel fhe prov/sions o( any ofher sfafe orlacal la�v iegula(ing consfruction or the <br />' peAormance o/consWcfion. That 1 am oufhonzeU by the o�vner ol fhis property to peAo�m (he E I� I'1G� � � 5Z <br />� i•:ork (o� whlch apphcafion is made and I comply �v;lh fhe Sfate Confracfors La�v 18.27 RCUJ and �l ' <br />� 296.200 WAC. i <br />! '�'�-1 ����!��- -�� 9/� 6 � <br />, , <br />Slgnalure � Daie ! <br />. � <br />I <br />I ' <br />� ,:_�_�rr:c:cn:----- --�� LL--�O—L(d/i__ I <br />