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� E TRICAL PERMIT AP�'!_IC�`TiON <br /> EL C <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FA7: 425-257-8857 —www.everetriva.org <br /> �/��� —8 g� <br /> �, _ �2 --�� <br /> �D33 3 �a�^ �V� �. ���►�.t�,�A. a�zo� g� �o-r � �o, � <br /> PROJECT ADDRESS <br /> S�\veX �a�le �CR-LLL \5�L6 u�'"�' G�SE M:�1c�1L W+� �ta2o� �25' 33o•�r°� <br /> IOwnef 4Aaili.tldress City State/Zip Pho�e I <br /> � ����a �x �llC _ 1�333 Y{�" k�12 S�• �vc.� v�p. �tP�e28 -- <br /> TCnanl h1ailAaCress Gty Stale2ip Ptone <br /> �,�,+e�� T �.°9°�'r1- <br /> l_npnwn e.`2G�Y1C, �4��� `�Ov.'t'� �•`�'�G� T4CDM�4 �1 .� Z�!1_0�20 <br /> �-- <br /> [lectrical Contrador Mad nddress City Slatelz�p �none <br /> Loaa�ne�a�� 04 �53n � 1� <br /> State Lic se Number(required) . Qty of Everetl Business License Number (required) I <br /> OE�r�CP �1000 �` <br /> Proposed Use of Buildmg Contract Price ol Worl; <br /> ��.w�e.S "C. <br /> Square Footage Q(residenlial new consiruclion, remodel or addilion) Contact PersonlCoNact mbedErnad <br /> Numbei o(devlces ilf low voltage) <br /> Descriplion of Werk lo de Done: ��M�n� �\Vh�rD�f1MP-N` } W"��fiC7 , �q�K��V� f- �'�'�v� <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 , /�O 0 O <br /> �,� <br /> 1 hemby ccrfily(hat 1 have mad and ezamined fhis application and know fhe sarne tu br, tnie and _ <br /> conecf. All provisions ollaws and ordinances yoverning this fype ol work will be comple(ed <br /> �vhetherspecified herein ornoL The gran(ing o/a pem�it Uoes nof presume fo oive auf/mnty(o PERMIT� <br /> violate o�c�ncel(he provisions ol any other state orlocaf law regula(ng consWction or fhe � -1 <br /> performance o/construction. That I am aufhonzed by fhe o�vner ol this property fo peAorm the E � ��( —Q C� <br /> work/onvhich applica(ion is made and!comply�vilh the Sta(e Contracfors La�i 1827 RCW and <br /> 296.200 Wfl C. <br /> ex. C• �wLc/— /(• /2• / y <br /> 5 nature Date <br /> eevrsFn oa�wlor. d <br />