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� • <br /> �LECTRICA <br /> L PERMIT APPLlCATION <br /> ; CITY OF EVERETT PERMIT SERVICES � <br /> 3200 CEDAR STREET, `VERETT, WA 98201 <br /> , 425-257-8810 - FAX 425-257-B857-ww�ri.everettwa,org <br /> fZ (���. <br /> ; ��� �,Z_� � � <br /> h1 i�� ' o � �l . � I � .-- , 1_ r ; � <br /> PROJEC7�ADDRESS ' <br /> � <br /> Q�ef . Naiiildtlress <br /> . G�' State/ZiP Phanc <br /> •��11. -_� . ..-i �� , • 1 ` - , �_ 1°�al 1+1err:l (� ree 12 �kli v � ����� � � r <br /> Trnant ; Mailqddress � k:�G,3 <br /> ! �'ry Slare�tip Phon� <br /> L�11•\(:t4.. i'Cr � af tSitc � �lic_ „?,�� �•" <br /> FJectriCal Con�rador ; .LS a,,4J l7�: ' r_ �[ � ,;. , i-(Jl1� �S"3 �/ <br /> , IAail Addmss Cily SIa1MLp Phone <br /> llv �i".S SS�l3 � <br /> State Licen Number(r uired) City of Everetl Business LiCense Number;required) I <br /> �_:��k-I; �....: i <br /> _�/.4 3'7,�� � <br /> Proposed Use o!Builtlin <br /> Contract Price of Work <br /> Square Foctage(If resideht�al new construq�on,remodel or adtlition --�'rt� rT r � F• r•�• <br /> i ) Conlact PersoNContad NumberlEmail <br /> � ��3-6,5/- �r;�� c�E.r� <br /> �153. :��ir- �3:1G G�4-��r <br /> Numherofdevices�lflow oltage) t��t;;,� ; �tlitul���sp;�r.��/e,;�(. e�'n� <br /> Oescnption of Woik to Oe ane: _j_ +� :���(j �1 � � ��«� ' � , ( � ,� , , <br /> 'x_`L� <br /> i <br /> FEE <br /> CITY OF EVERETT LOCA SALES TAX CODE IS 1105 � �y� <br /> /'���CJ <br /> I hereby cerlily(haf!have cad and oxamined t/ris applicalion anU kno�v!he same to 6e Inic and v <br /> carrecL AIlprovisiansolla �sandordinancesgnveminglhlstypeof;vo�kv�illheComplelod <br /> �vhelher speciltd herain or riof 7Ye grantmg o(�pwmit does nn!presume lo qive au(hon y to PERMITN <br /> violato or r.nnce!the provisr os of any olher stafe or locol iav�regufaGng conslroclron orlho , 1 ���777 <br /> peAonnance of consfnictio .; Thal f am aulhcrized by fhe ownero)fhis propertylo pedorm Uie � � u I ���"�S�/ <br /> worN for which appLcaticn i inade and I compty with lhr, S(ate Conlracfors Law 18.27 RCW and T O <br /> 290 200 WAC <br /> 1 G'-�a. 3,� �-�-Ca � :� - /'� - I c/ <br /> S�gnalurc � � �ate — <br /> i+[�S`JJ 080Y10�< <br /> � _ <br /> g d yg£L l68£SZ 4�01 swolsRg eni�enouul d£0 £0 b L Ol �eO <br />