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� <br />� <br />ELE��RiCAfL ��RfViOT' AP�'Lo�A�ION <br />/5 <br />PROJECT ADDRESS <br /><�Sdv��- <br />Ovmer <br />„ <br />ienant <br />�Um2%� � <br />Eleclrical Contractor <br />CITY OF EVERETT PERMIT SERVICES <br />32U0 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />����7��/V ILV <br />�(�C l ( ��%%G� L���v� <br />I:tail Address Cdy <br />« , <br />� .� <br />Nail Address C�ty <br />/�2 �C�G�'L�G 125aUSs�Av� S£ <br />Liad AdCress GIy <br />,ti�z�y2S ��� � s <br />State License Number (requ�red) <br />Proposed Use ot Bu�ld�ng <br />Square Fooiage (if residential new construclion, remodei or addilion) <br />\umber of devices Qf low voltzge) <br />��.� ��f�12Gy <br />State�Zip <br />Slate2ip <br />�(1�7�� �,4 <br />Stale�Zip <br />�s'�t �� / <br />Phor,e J� <br />zs �= �s <br />phcne <br />�zf ?Z7-,?ZZ � <br />Pha^e I <br />��s ��r3 <br />City o( Everelt 6usiness License Number (reqwred) <br />�pNA i 7_O� <br />Conlrad�k <br />�-cj���c £_ ��Zo r.,��J <br />Conlact Person/Contact Numberi[mad <br />�fZ�-,�Z� -i� �� <br />�S�LUL �%FLd✓l <br />yls-�z� — 3zz� <br />DescriptionofWorklo�eDone: �2�LOC�! E avtf �Zdvoi; S�l� <br />CITY OF EVERETT LOCAL SAIES TAX CODE IS 3105 <br />i <br />1 hereby,:e�Lly fhat l have mad and examined lhis applicalien and kno�v Ihe same fn Ge frue and <br />correcf. All provisior,s ef fa�vs and o�dirances 9oveming (his type oI �:ork �vdl be complefr.d <br />�vhether specified herein or nof. The granlmg ol a pemut does not presume fo give aufhonty (o <br />vio/afe orcancel the piovisions oI any olher sfafe orlocal laiv regula(ing consfrucfion orthe <br />pedonnarce olconstruc(ion. That 1 am aulhonzed by fhe o�vner ol this prupeAy to prAonn the <br />�vork !or which applicafion is made and 1 cornpty �vith f/ie State Confractors Lar� i8.27 RCW and <br />296.200 WAC.� „ <br />'-27-2d <br />FEE <br />� �v <br />PERMIT�f <br />EfS�y — I�C� <br />