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d25-252-1666 CM HEAiING 10:19 53 a.m. i7-04-101L 3�4 <br /> ELECTRILAL PERMIT APPLI�:ATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 320� CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.evereltwa.org <br /> 12-Y-�4' <br /> C iy� z-U�-� <br /> 7�0 3 Olun-+�t.c� ..1�'' <br /> F'ROJECT ADDRES <br /> ��v �u�l.a, �� � a,�Y� '�z5 870 `�88 5� <br /> Owner Mall Add�ess C,ry Slale2p Phonc <br /> 7enant e.tail ACdress Cdy Slalc/lip Phonc <br /> "' � n� ( n� l��i� �i��ccl�uru.r �,'e��i-f� �uA �1�20► uZ5 Z�1 �:G-1�:1- <br /> ElecUic21 Cant�a or 1.!aIl Address Gly Slate2ip Pnor,e <br /> C�1'1�1t7aNINR�� ��1 O1 (oo� 8 <br /> Stale License Number(requlred) City o(Everetl Business License Number(required) <br /> ��.�C.l <br /> Proposed Use of 9ui!ding CoNrac:Pnce ef Work <br /> ��.d�,� �I-Z5 z.s� ���� <br /> Square Foolago pf rusidenlial�ew constructicn, remodel o� .ddillan) Q�ontaci PersoNCon!acl NumbedEmail <br /> Num6er of device, Qf low voltage) <br /> Descriplian of Waik to Dc Oonu: _ II IS 1(M�{ ���/2.1.,��_�J `I� � <br /> f 5fdf �� <br /> FE[ <br /> CITY OF EVER[TT LOCAL SALES TAX COOE IS 3105 �D� <br /> I herr.by certity fhaf I have mad�nd r.ramined fhis applicalron and knuw Ihe same(o bo fruo nnd <br /> ca�recL Aq p�ovisions ollaws und ordinances yuveming fhi;typo o!�rurk H�ill bo complufad <br /> whether speciliud hemin ornoL Tho granling ol a punnit docs na(presume ro givc au(honq�ln pERMRY <br /> violafe or cancol(he pivvisions o/any other s(afe or focallaw rogulafing canstnicfinn or thu � t <br /> perlomiance o/consWc(ion. 7haf 1 am aufhonred by�ho owner o/fbis property fo pedom� Bm I � I Z' O�� <br /> work forwhich�ppllcafion is made anJ 1 comply with fho Sfefe Con7ractors Low 78.27 RCW and <br /> Z96.200 V✓AC. � <br /> . 'l <br /> /� ' T / <br /> Signa�um Uaic <br /> r <br /> HEY6EDC896^.J1� <br />