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� � <br /> �--- ---- --- - - --- -- -- � <br /> � ELE�TRICAL PERMIT' APPLVCAT'ICDi� <br /> CITY OF EVERETT PERMIT SERVICES <br /> � 3200 CEDAR STREET, EVf=RETT, WA 987_01 <br /> j 425-257-8810 - FAX 425-257-8857 —edvn�d everetltiva org <br /> i s -09-�v <br /> � �IYo�--�� <br /> i � �'u� �� ►-- �l v�P <br /> PROJECT ADDRESS <br /> j _I�c�ln—S1•���—J_�.?�—�cCPY�s�e �'���P�' 9'�z7z <br /> Cv+ner �daJ ddress Gty Slale2�p Phene <br /> � <br /> I Tenant ��1adildtlress CAy SlateR�p Pnone <br /> `�2�-�1.�—�/ 2 E <br /> ����2�l��lq�_� �C�7-�'�C ZS�i� �C��� c.cJo r� -- <br /> i El�dncalCenlractor ��1adAdCress C�ry Stale2�p Phone <br /> jL�r1� �� �LI`.�` �� -- <br /> �. Slaie LicenSe ��umber Cuniract Price a1 Wa§ <br /> i <br /> _��uZ� � <br /> � Pwposed Use of Budd�ng Cnniact Persan (Plan Rev�e:i) <br /> Syvare F o�ge p(residen�ial new construction, remodel or addihon) <br /> l�C7l� - <br /> NumLe of devices (il In�v voltage) <br /> Dr,scnption of Work �o Be Done�. �J_TG�f G,[ij ✓e l�+�7Q�C.{� <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 �� �O <br /> � <br /> 1 hereby ce�ldy Ihat I have read and examined this applicalion and know Bie same fo 6e(rur, and <br /> conec(. AN prm�sions ollaws and ordinances goveming Uiis type o/work wdl 6e compleled <br /> ' whelher specified heiein or nof. The g�anting ol a pemiit does nof presume(o give aufhonty fu PERh1T1�rt <br /> violafe or cancel Ihe provisions ol an y ofhe�sla te or foca!la�v regulahng consln/clion or fhe <br /> aerfurmance ol conslnulron. Thaf I am au(honzed by the orvner o/fhis propeAy fo perlorm the E 1 y �j —OS� <br /> n�oik!or which appLcaf�on is made and!comply nvfh fhe Sfa(e Con(rac(ors Law 18.27 RCW and <br /> 29G.200 WAC <br /> ��<��'�/" ��� �'-�L-- �-��"-L-�y --- <br /> Signature Oale <br /> 4 <br />