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v -- <br /> • <br /> • <br /> ELECT IC L A -LICA: <br /> T� <br /> CITY Of EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 4=25-257-881.0 - FAX 425-257-8857 - www.everettwa.org <br /> 0 €_ 1n G� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> • <br /> • <br /> • <br /> ,... 0.a:,. 31—y ..,b1/7, :( '.e:s . v.e. ki4 ?e02473 <br /> ; � #-:.. e.v'r`irl/ e1^ce..iZ PkGv 4425--Yd <br /> Owner Ma►i:Address �'1 y!oo <br /> City 1 t Statjz p 74 F.25!Phone <br /> 5...'4W/ <br /> Tenatttt- Mail Address <br /> City State/Zp Phone <br /> / 7s2, Z 3S" ' `�� q`Zry- 7Y 974 <br /> 5 Al Cie S c G r t*C 41r.c 14.i, 4 kI h k/da►f' YV 4 /iQp -7 <br /> .f t ical Contractor Mall Address City / <br /> • State/Zip Phone <br /> ,.. '-:. .. ...5 -/A766: r9/. . q3 .3 .-- <br /> -101. ." d vO ...--- <br /> =te license Number Contract Price of Work <br /> Ods y^ v� L C� &( i^ <br /> .ropos 'd Use of 44110�y - r r'- 6-7 0 S" <br /> 7-..---+, Contact Pe/son (Plan Review) <br /> Description of Work to Be Done: k- - / <br /> - t-, T / c-, ?____,,_ w U Cl_c1 ii- _ i c7X t'S ` <br /> • e-.!JGt .7 ...-.e. v.,:e... , c c__ /eL7C s ( - <br /> NOTE; WINGIRII `f�lt� i 31V L:L.INQ�5 IS REQUIRED TO FEE <br /> • BE INR . .EE1I5..!Alr$, MC OR AC CABLE. <br /> 325` r <br /> CITY OP RVERE'ITLOCAL wee TACE.: :QDE.IS 31.0.5 T. <br /> thereby cert/6,that I have fead anri.;exarnined this application and know the same to be true and <br /> correct All provlslons of(aws erns ordlnenoes governin this type of work will be ,6-7.1311 r <br /> whether specified herein or•:no't 'T'he grartffng of a;permit does not- resume to give authority to D J <br /> violate or canccl.the�provisions f any other state or focallaw re g u tin construction or the <br /> performance o con's ructlgn: Tat;I am f utiorized:by the Rymer of'thi 8 to perform the <br /> work for wl ich•a•.pllc:fon le made and I eoifrply with the Stale Centrelaw 18.27 RCW and <br /> 296.200 W. . <br /> s <br /> 72--- ", <br /> Date <br /> • Signature• - /f7 /73 <br /> .r., -, . <br />