|
�L �� � �����. ����I`� a�►I���.r� �`l�
<br /> CBT'Y C)�' E'�IE��TT' PEM��IT ���V10E�
<br /> �200 ��C�A}� �'�'f;�C�`, �V�f��1"1`, WA 982Q1
<br /> 4����57-88`1Q - �'�1?� �1�?�--��r�����` �- � % �
<br /> � .�7 - �� 't,:��:r � �� �-� � �::�"� �,4Z�,?. „2 :i
<br /> �.i'1�E.i,;(� ��. +r GE,f�l"� T"�', ` c.1t� ' 4� u1 �� ���
<br /> t y" �r� � +�-'t�f:�i`+;E�"�i C�'.fe:? �J 1�
<br /> ��
<br /> � a j_ � 3 �
<br /> � ""- y .�t,'� _ v��
<br /> '..>�.T`.`TY.c--.^'�:fC.�r'�.^ T._�.��"'��'e-�_...^^e-.�v,;•�-_� _.. _ __ . �.__ .. -.-_.��-�-�-.e;yew.��.Rw
<br /> f��C�J���"A,DDR�SS
<br /> � E"�1s� . ' ��P ti¢�F�` I �?rj '� �,;�� z ,-�=-, � r'.
<br /> ,� at;<� ��R�� �y �-�;i (
<br /> _��.�n� �;..��<�.:_�-.�-_�--�<.r �_
<br /> � �
<br /> ��anar .�-__ ._�.�,_,.-,._-.�..a.,��.....�.,...,-� _. .�-,..-,.-,�.-....�.� _ _. �.�.�.�.....
<br /> ftlail k��ldress ��a��,�'�'�
<br /> y .. i �/ .�j �;if} �tat�/"l.i�a����� Phon�
<br /> � ;��i�;Y��.�di� �v�'��P�-� ����;i9�Z •
<br /> � - t('°°��'i"�i � {�v �>> � �'__ ..
<br /> -��,.�. .� ..�-..-><�..�._, �',..�--.
<br /> � M�-...s..�-�-.�._,.. �_,..._._.._,.,,-,�.x.a�.:.,,._.�,._-,,,,.>�
<br /> -, _.. . �.-,�.�,.......=..M...__ _
<br /> `�Et l'�I'I� ...
<br /> - �'�I���A�C�fC?SS _. _. .
<br /> �ifY State/ZiP �tion�
<br /> r4 .
<br /> �'�'l��lf:i����? �,��'T)�1�, %� i '-��1� �?
<br /> (G l;�X � � I;�; 1--�,��+1�s.�J � 4; �•,, � r,-�
<br /> ., �, I !i G�,a U, a-
<br /> ,ZS) cZZ�2c� IZ
<br /> EleCttical �;ontractor Ma11 Address City S ta t�/Zip �hone
<br /> �(`•'�_,�'�j��L�' ;( ���� �..r`� � 11'"l: i `1
<br /> �tate Ucen�e Numlaer(r�c�uireci) G+ty af Everett Busir�e�s l.icense Number(required)
<br /> (�(? k
<br /> t�4 Y��I L.��J.�;I"��`�j r 'u.` �' + �'�.
<br /> -��
<br /> Propased Use of Building �ontract Price of W�r�k
<br /> � �. .__ ,.
<br /> ..� C"1M.S:,i�`t i� i'-;�'C'"t'4W�7..t i;r•+i`t.r�-' ,�,�.!E.i rvV,�'}�v'1
<br /> Squa�e Fciqtag�(if residential n�w eonstruction, remodel or adclitiQn �""�"` �
<br /> ) �ar�tact Persan/Cpnt�ct�lumbar/Em�il
<br /> Niir�b�r a�de�%i�ti� (If inve yolt�g�)
<br /> aescri�tion of Wurk to Be Done: �=,�fL��':1^7C. L'1�(:" 5%�iV i rd " `
<br /> � �"'� � � l�,t j'��:'�1C.i�Y`�'�t�'J'u<:�_ �;}^.. (.:i�ri7..,,�. l
<br /> �,n —__-------_� "-�."
<br /> �_._A�?=��a`��._.�,�.:,�.1� j_ (�f� '�i�l� ��:`L t}.� + �l/\C�� ` 4 --� '�l>� �--- - { ,�
<br /> - � ti ,�
<br /> - _" ._.m r„_._. ".,�___._._ ____
<br /> ���
<br /> �I°i'Y 0�' �V�R�`fT L��AL�,4L�� 7'AX COD� f� 3'i05 �/��� �
<br /> !!I
<br /> !hereby certify that l have read and examb�ed fhis applicatian anclJ�now fhe same fo be b�ue and �
<br /> cnrrect Al!prpvisions of laws and ordinances gaverning�his type of warlt wil!:�e eomplefed
<br /> whether specified l�erein ornot The granting of a permi�doss.nof presume to give aufhorlty to p�RMIT# �
<br /> violata or cancel the provisions of any other state or local law regulating canstructian or the
<br /> p�rformance of consfrucFion. That�l am authonzed by fhe owner of tl�is pranerty to perform the � 1`� ,�,. ��
<br /> work for which applicatron is made and(comply with the State Contractors Law 98.?7 RCW and 6 .J
<br /> 296.2D0 WAC.
<br /> �
<br /> ,�.�� ;' .
<br /> �,�� '-.'l .
<br /> /.L� ;Z � i`-� ';•
<br /> Siyriature �� � � Date��"—'—` � -"'�'—"
<br /> �
<br /> rteVrStpoaEas�2a•la �f�L�'�- "`rr(1 �:, �`�j't�j ,
<br />
|