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Oc �. 14 201� ,� SSA'�1 � — I�o. 0227 F. 3 — <br /> � <br /> ELECTR�CAL PERMIT APPLICATION <br /> CITY OF EVER6TT PERMIT SERVICES <br /> 3200 CEpAR STREET, EVERETT, WA 98201 <br /> a25-257-8810 • fAX425-257-8857 -www.everettwa.org �d�//a../3 <br /> APPLICATIONS qRE ACCEPTED FROM 8 AM 70 4 PM �/3�D"��`� <br /> � <br /> I <br /> aSl� �I�oru Ev . qg2� l <br /> PROJECT ADDRESS <br /> `1 '� [ �P Q��a�� 25 3 Z2.4 (�00� <br /> Ownet MBII AGEres7 Clly SleteQip Phone <br /> 1en3nl MaIIAQEresn � Cily Stale/Zlp Phone <br /> C m �ea-�r� lne I�15 gr�dwav EveretF WA 9�2p I �_2� 25q t�(��G� <br /> Elodric0l Conirac!or Mell Atldreac Clly StalelZip Phonc <br /> cm��r�M�aao��a 250 � <br /> Stalo L�censo Number Conhact Price ot VJork <br /> Proposed Use ol Buuding �—f —J Contntt Per9on (Plan Review) <br /> n.� ✓u �': !1 � 1 It`1r3 YY�V 1� i�..- <br /> DescnpUon of Work to Do Done: �, i ►Tr <br /> - -� �t��- _- --- <br /> NOiG WIF2ING W NON•DWCLLINGS IS REQUIRCD TO FEE J I <br /> HF IN RACEWAYS, MC OR�C CABLL. I <br /> CITY VF EVER@Ti LOCAL 8ALE8 TAX COUt 19 3105 _ ___. .. <br /> �hereby cerilly fhaf l ha��e rot+d nnd erammr.d th�s opplicn6on anU know tho samo fo be huo ond <br /> rorrer,l AO provisrons nf lews ontl nrdmunces�ovemmp flus lypo ol work wiU bo cornpleteU <br /> whefher spocil�ed hormn or nof. 7hrrVranhnp ol o pnrmrt dons nnt vruume lo y�vo nvinnnty fo <br /> violalo or canco/Ihe!irovia�rons ol any ulhor stafe ur lucaf law rvgu�afing wnsfruchon o�U�o <br /> podormance ol conslrucGon 7ha!I am oulhc�lred by fNn owner n/fhls prnpr.rty to peAnrm(he <br /> work !o�wlrich eppliC0O0n i3 motlC O�d 1 COrhply wflh(hD tifBfn Conl�AfiOr^LnYv+n��r?r_wand <br /> 296 200 N'AC, <br /> ���� ' �.�. '�. �I��.I� <br /> I ��ignalurA UMe <br /> L_— ___— _ ___ ". _. . __�. ._.. _—.. <br />