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r-.o�,,. ovazi2ois ia,oe oneo v.00 ��o❑ <br /> • � <br /> ELECTRICAL PERMIT APPLIC./-1TION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 C[DAR STREET, EVERETT, WA 98201 <br /> 425-25�-8810 - FAX 425-257-8857 -www.Pverethva.org ��SOI—//'�1 <br /> � �a3-�s <br /> �3oa wl� Q«. C2�c- �na.r�� S�,r� �ya�, N�lurT,,�A- qe 203 <br /> , <br /> PROJECT ADDRESS <br /> Owner h10i1 Address Gily SlalelLp Phone <br /> � L►'� S4 5 T'��� M - v� rvk r7t�,u r�f�rzu-�r �,1,�ta�?�� <br /> Tenanl A�ail Atltlmss � Gry Sute2p Phono <br /> �oN-+PvL 1�- arv�;u rNc 11 E' M�o,,.,�- J�� ?� t�lrPrn- �.•1�r �f9?�x �12s-5�3Lfo ry <br /> EleclriG21 Contratl0r Mail Atltlress Ciry State/L0 Phone <br /> �o,.� �r /ri;.l/Yl � 0'�53�q-) <br /> talo Llcense fJu ber(reauired) Clty of Everett Business License Number(roquired) <br /> $ IQi�oc�0 Oc7 <br /> Proposed Use of BuJding Contract Pnce of Work <br /> SQuare Foolage pf rosidential new wnslruGion,remodel or addition) Contacl PersonfContacl NumbedEmad <br /> Number o(devices Qf low voltage) <br /> Descnpbon o(Work to Be Done: �NSTM.�- �iIJ h-wP ��D�! C�2c� �� �� 2a/�uP 171J� (��2Cu�T <br /> r <br /> �-- �G.�) �,Q�f� G�1 �i� �� FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 ��O d� I <br /> I haroby ccQ:/y thal I havo road and oxaminod I/ris applicofion ond Mnow!he sam�fo bo frue and <br /> conetf. All provislons of laws and ordinancos goreming(his f ype o/work will bo complelod <br /> whefher spociGod heroin or not. Tbe granting ol a permA doos nof presumo lo givo aufhonty to PERMIT# <br /> viclals or cancel flre provisions ol any ofher sfafo or local law rogulafinq conslrucfion or fho � � � <br /> pe�lormence ol consfrucfioa That I am aulhorized by(he ownor ol fhis property fo podorm Iho �501 ' I I <br /> work lo�which npp6cahon is mado and!comply wilb fhe Sla(s Conlraclors Law 78.2T RCW and � <br /> 296.200 WAC. <br /> / <br /> . D( / ZO/J <br /> Slgnaiure " Datc � <br /> I <br /> I wFv�sEecsvn:o�. af rL� rfl�f Td �ZS - 3�s" �8 / � � I <br /> i' <br />