|
11/02/'L017 08:52 FAT 425 377 1976 RE1 ELECTRIC � [�001
<br /> �
<br /> � �� �� � !� ��� ��
<br /> C{�Y OF �V�Fd�TT ��RMl�i ��RVi���
<br /> 320t)C�DP�R 5��2���, �V��El"�f, �N�! 9�20�1
<br /> (�')425�257'-�8�0 E i�AX�25-Z5�-��57 � ��)�ver�lt�p�a��v�retfvva.gav � w�rrvv.�v�r�ttwa.gov/p�rmit�
<br /> P������" ��"�°� �����.��"C9��
<br /> Iat�QJ�CI",�l3DGdE s:: P .,��° "�' � � �
<br /> �L9@Li�i�dC AF��(if residentiaf, new constructiori, remr,,def,or 7dciition) � _ �5F ___ PU'1 ��
<br /> �'UIL�iPdG 7'Yt�E: I�SE#2-S��TAC6�4ED Q 5Ff2-ATTACHEC3 �DUf�LFJ< • �'11�LT1-�/a�91LY-+`•OF tJNITS�i C�l COfl/lNJ1�F;ClA�
<br /> �..�_.____. � –
<br /> I�iS�OF BUlL.DlPd�: '
<br /> 1��..��`�'�����. ,����1�s��"��� ������/$��"���
<br /> �vr���,aac;�r��sc�o��o��c:� � .Y.._ ...�.�.....�..�.�.e.��.�.
<br /> �iQ��(3����C3E=CJ��fI����foev voitaqe�:
<br /> �f6a�.4L.a,4"v�fi? Cl 1✓�� iml S�i� _�� �• -
<br /> �A a�CS�@�6'��1���31�.�5�1�P���I�'� ifi�a lit;a3ale):
<br /> ���CF�1{��'IC�i�I f.�F 4��f��C, �`" .a.,,, '��,'��'.r�g'a�`1�_.,�� � �.�..,�.� �'m �.,� .��
<br /> �
<br /> �O�`�",�,�'�' �������`�°���
<br /> �,� g � ��.
<br /> �U99io9�E��3dSRPlE: ° �i.�� � `s���. 'T��dA��'i�Af�9�(I�Curs�r�rsflr�iaBD: .�...m...
<br /> C3�Ji^d�Fi t'�i�1iLIh3G�nD���u�: s-rr,ees ��;j4� � �e � ,�"'�t@,,.�a� ��,"'° -,a� ----
<br /> _„—. Gl Y SmR' `� STi.% � �� L.a �Ay 7 'g,,,,
<br /> �/ g �,� �_� a
<br /> ,�.
<br /> C7G°VPl�F�E�i-i�Rl�: �`s�'�� ��,*�"��� �"� `��� ��'J�d�R��96�lL: ��`� � ,� _ a�
<br /> .g�»�•�������ae���•��� �4a����������'� a�• _______�,_.a.. , —�_..�..�__ _ _�_____ — ._._.�...._�.
<br /> t:t?�dTF�,�(:'COFR da�3C1€d�aS: 9°�1'�`�,' '�ffi��a �°�'���,�,.,.�. — - --- .��.�. -- ._..
<br /> �,Z���$�'d�Qa����a���s� >?'nTe---��----m--�-�-•^ Z�.'-�-^--_..__,.
<br /> G�Re�'���"��f��F�C���:4�:s�2����� ���d'���'T�3R ��3iA61�: ��o���C���ae�a�a�,�cssa� ...,.�__.�
<br /> - �.�.��.��
<br /> �QPa3"4dAG'�'CtR�.EG.�(Ft��IE�...���?��?��'& ��'f�l�C)��R��r`��T�'F�@la;9�°�5��� L.,�Ca.�Q4$����
<br /> �Fa6P�RA1�Y C�id"f6AC'f: nZ� pWf�dEF� �1 CONTR�CTC7F2 C�O�l�N�r�(i'leas�SpecifY)
<br /> �Ol�$�'i�C3�61�A�:�O�aP��a'@�°�k� ��,.a.•_• C�tdTAG7'PF49{�i�:����$2am"97�
<br /> �d�a�'AC� ��ti..:rra���a���ga�a�6.�c�rr+�w.....
<br /> fiGR�EP.�C1V7''7'hen>6y ceriify fhaf I irav�read�nd exam;ned thi;application ar,d l:r,ow fti,�5ame ro be�true�snd co�reci. Atl rruvisians oflsws and orcrrrancfls govEm;i�r�this
<br /> ly�;of tivorf;�vill b�complef�rd cvhePitRr spscifi�d l;a�in or rot. Tne r�rani�nr�of a(ayr7nrt does not pr�=scme to g;ve aui}�orrty to v;olate or canc�i the p�ovisrons of ar+y othor sfate or
<br /> loCal!av,���u13t;r,g ccnstrtretion or fhe�ri�mranCe oT consPrveffcn. Tf�aP I P�m auth,orizerl by the ovmor of thrs pi��.rt�to pafiorrrr Sre s�c.•1c turwhici7 app?ic�tion is made and l
<br /> comply with tha Stat�Confr:ctor'L.a�v 98.?.7 RCY✓er,d 296.200 l�✓AC.
<br /> City of Ev�r€�tf Oflic%al Usc Only
<br /> F�E �•�A
<br /> � �j ��
<br /> � ��-����-�
<br /> �� ;� � ��-�'� ----- �.� � � _ �. �� I I -- Z�
<br /> O��rne��lA�rtl�oo�izaedAgen�91gna8ure D ;e (Revisod90/i2/2015)
<br />
|