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� <br />- -- � _ .-- - - <br />EL.�CTRIC,+4L PERNi1T ApPLiCA.�"��N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STRE[T, EVERETT, N!A 98201 <br />425-257-8810 - FAX 425-257-8857 — vnw� everettsva.org <br />d'�2� �`�� C�l/L ��>sd� <br />PROJECT ADDRESS <br />/l� � �CJ �QY Q � Zd ��.ti ���Z (.(� L vc rC d <br />Ovmer �datl Adtlrzss Gly <br />n/� <br />Tenant <br />(:iail Aatlrc55 <br />� <br />�mc �, �lecd��� zq65'3 l26f�h✓�=� S� /�%�(buvh <br />Elecirical Contracter ':taJ ACdress C�;Y <br />I r�,�,1 .� �� 9� z JF _ <br />I SIa",e Licensc� Jurnber <br />Picuc<_ed Use of E+i,dtiira <br />Square Foo;age QI residemial ne�v conslruction, remcdel or addition) <br />�� �:umber of devices pf low voitage) <br />� <br />� Dcscnptlon o1 Nlork to Be Dune: <br />I--� ---- -- --- <br />�%an `�'.---��L(�C✓ fJnc� <br />I <br />Gt/� 9d a� y � <br />i <br />Slate!Lp Pho�ic <br />s�d�Erz,a --� P,,��� , <br />��� 2 UG -��ll�-lI 4 y i <br />State/Z�p Phore i <br />/.:c�0. J� � <br />y����� <br />-- - ' <br />Cr,rtract Price of'iJork i <br />Ccntact Parson (Plan Reviev�j <br />��ca�r�c0 � �pne� <br />0 <br />.... ---�--- <br />rF�E <br />CITY OF� EVERET7 LOCAL SALES TAX CODE IS 3105 % 1-�� C�� <br />1 <br />! he�eby certi(y (hat 1 have read and examined this app6cation and kno��v the same tu be t�ue and L___ <br />cenec(. AU provisions ollaws and orzlinances yoceming fhis fype o/ work �vill be r.ornp/e(ed --- <br />r:hefher specifieU hcrein ornoL The granfin9 0l a pemut does not preswne in give aulho�ity tc PERh1IT?i <br />v;oiate or cancel tlie provisions o! any efherstate or local ia�v mgulatiny consWction er the r I� I rl` I�� <br />per0om�ance o/ :ensfn�cfion. Thaf I am auNwnzed by Ihe owner o(lhis property fo per/orm the C �J <br />,.ork Jor ��:hich apphcation is nrade and I comply �vdb lhe S(ate Confrac(ors Law 18.?,' RCW and _ <br />206.�00 l4'.1C. <br />�/��� ,��,��zo,� <br />._.. _--sa�-a�ure oate <br />ar �. _�:� ::.... ' , <br />