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�LECTRICAL PERMIT A�P'LICATf�f� <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CE�AR STREET, EVERETT, WA 98?01 <br />425-257-Sd10 - FNC 425-257�857 — mvw.evenettwa.org <br />� � l� D�- �,g �' �- S� <br />PROJECT AD�RESS <br />OWnrr <br />?onanl <br />Addmss <br />M:JI Addrnss <br />ciry <br />c�ry <br />�-I"�-1 S <br />E � sa g--�6 3 <br />�,�5. � �� � , �a <br />SlafilZip Phone <br />Stoto2ry Phonc <br />�w„�,n_��,�� � � o� s �3� �� ��.�. � 9�B� tos aoe���3� o <br />Electrical ConlrBdor Mall AddrPst Ciry SlaIaIJJp Phonrt <br />���� � <br />State L�wnse Number (rrquired) <br />S�� <br />Pmpocad Usn of Building <br />SyUare FoolBge Of fesidenfial new consilUClion, tumodal or addition) <br />Num[wr ot de�icrs (�� �ow vollage) <br />Uescrlpllon of Work to He Oonc: 1 f K�J-W"'1 L"�, � v <br />CtTY OF EVER�T7 LOCAL SnLES TAX CODE IS 3105 <br />oa �a 3 0 <br />C�ty of Everclt Busines� Ucerrse Numbor (rcquired) <br />� 3bo <br />Gontract Priw ci Work <br />� � �-I� _:� � �. �a.� <br />Con4�ct Person(Cont�cf Nunt�erlEm311 <br />1 hAie6y ceRify that / havo mod ond exnmJned Ihrs upplir.ation anJ know t�e snrrre fo Ga ln�c ond <br />correcf. Nf prpyisrons o/ faws Jnd ottlinances goveming ihis rypr ol work will bo rnmplotod <br />whefher sPecifie+d hercvn or nol. Thv gront?np ot a pnrmil docs not presumo fo qivr, nuff�onty fu <br />v;oL�ta or cancvo7 fhc provisrons of ony oUrcr st�fn or foco!!ow rr.�ula6ng con5WCU0� a fhc <br />poriomTance oI const/uc6on. Thnt ! anr aulhonzCJ Dy the owner o! Ihis pmpr.rty to pedorm lhr. <br />wurk ror whr�b epplicatmn /s m�de anA! comnty w17h Mn Statn Conbacfcrs }.:�w fA27 RCWonJ <br />��5.200 WAC 1 <br />nttir.sn onnvm ia <br />FEE <br />� 5D � °° <br />PEHMClY, <br />E l�b� � D(�3 <br />� � �+' ��Ii��S <br />