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ELECTf�lCAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STR[ET, EVERETT, WA 98201 I <br /> 425-257-&810 - FAX 425-257-8857 -�w,w.everett�va.org <br /> 3 _ /z--/c{ <br /> � ��uo� -o�d <br /> � �i�� r �i��4�,��-� T�r i <br /> PROJECT ADDRESS i <br /> � �ZL E �j� �/p/l�P - <br /> �wner �� IJ�a�lAodms� G.ly SlatelZ�p Phcne <br /> � <br /> �i Tenanl tdadACeress Gty StatclZ�o Phone <br /> � <br /> i C3.3o�1�I1���-�• �P��Z� C�r l�t/c, 9fs o/� �l15�31�,7� <br /> �� EIeCIrC3iConh3tfor L1a.iACoress Cny Stafe�Lp Phonc � <br /> W l LZI�T —�/y-oo�. <br /> � '"�L ��� � ^ �Z Confract Pnce of WorY, I <br /> S�ale L�cense Number <br /> i <br /> .�o45-r � <br /> Proposed Use ol BuBding Conlact Person (Plan Rewew) <br /> I <br /> ISqoare Footage Q(resideNial new conslrudioq remodcl or addition) <br /> Number of devices(I(low voltaye) <br /> � Uescnptlon af Wark fo 8e�one: !`�C ,Q1f���. � � 1L(��4�/�I�� �P/�( 1` <br /> / / <br /> FE[ —� � <br /> i <br /> CITY OF EVERE7T LOCAL SALFS TAX CODE IS 3105 �C D . <br /> J <br /> I hereby ceridy fhaf I ;iave read and examined fhis applicafion and kno�v(hc sanm fo bc Guc and _ <br /> cormct All provisians o/larvs ard ordmnnces govr.ming Ihis lype of�vork u��ll Ge cumplefed - <br /> a�lic(her specilied herein ornoL The granfing of a pem�if docs nol presume(o givc aufh�nty(o PCRh1C1� <br /> violate or cancel fhe provisions o!any othr.r sfafe orlocal law regulating cor�sfrucfion er the � � � O ? _ O[ / <br /> peAormance o/consiruc(ion. Thal I am authortzeA 6y the owner o/this propeRy to pertoun Ihe � .7 4O i, <br /> rvo�k Im-rihrch applica�ion is made and I compty�vRh fhe Sfale Conhaclors Laro 78 27 RCV✓mid <br /> 296 200 6YAC. <br /> L%l/ //�_ I <br /> Signal�re Date <br /> � �r-r�s[�; i:mu <br />