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L <br />� <br />ELECTRICAL PERIVIIT APPLICAl'lOf� <br />CITY OF EVERETT PERIIIIiT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — wv�nv everettwa.org <br />�yZS � r/� '� �� CcJu.�,� .�'-�c.c.��./ � . <br />PROJECT ADDRESS � U <br />Owner <br />MaJ Address <br />Ciiy <br />��r7d�o� �S 7���f� fU122.�.�s�ir �✓��� <br />fenant Ma�l Address City <br />�.�� �c, �'S,� l� .���� �� f/-'� <br />ontrac�or U miad <br />��rRf� S ��'�13P <br />Sla�e License Number <br />�-Y1�ST�Y �c Wcu-(' �' �Lt� � ��/�r�� <br />!�� <br />Proposed Use u! Building <br />Square Footage Q( residenlial ne�v construction, remodel or addilion) <br />�. C:�� <br />Number af devices (II low vollage) <br />Description of Work to 6e Don= <br />� v <br />/ o �u <br />' C�OLu-c,f7 D 1'��i • <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3 i05 <br />Cdy <br />�j_ zZ-�Y <br />�/�f0y�lq(� <br />State�Zip <br />��z�3 <br />Statz/Zip <br />�iz� <br />Slale/Zip <br />� — <br />Phane <br />�, <br />zcY�-2� z � <br />2�� <br />°honc <br />Contraci Prite of Work <br />/��/ _1 O.S � h� �r2Ti i.1 � Z <br />(�i°-uieGT/6'�s . <br />Contacl Person (Plan Review) <br />�lo—d'j�9' `F z� ` <br />3 � %�-a LcJ 1" �a <br />1 hereby ceRify that I have iead and exarnined Oiis applicafion and know fhe same (o be frue and <br />coriecL All provisians of la�vs and ordinances 9oveming this type ol �vark n-ill6e complefed <br />�vhcther s�ecified herein ornoL The granfing oI a permit does naf presume to give aufhonty to <br />violate or cancel the provisions o/ any other sfafe orlocal la�v regula(ing tons(ruclion o� fhe <br />perfo�nance oI constnrclion. That I am aulhonzed by the nwner ol this property (o peAorrn Ihe <br />woric for which application is made and I comply ivdh !he Sfate Conlracfors Law iE.27 RCW and <br />296.200 Wi?C. <br />iatu� <br />� <br />IRE:45E0 L.'J1] <br />� /G ��� �� <br />FE[ <br />��V <br />� �ERMIT;t <br />E i �-10� - «�o_� <br />