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OG/�3!�G•_� '-f:'-7 3604740:t"G <br />PJNN"niSGN E:.°CT�-C :NC g�693 P.GG1 /CG1 <br />E�E�TRICAL PERt11�[T APPLIGATi�N <br />COTY OF EVERETT PERMlT SERVIC�S <br />3200 CEDAR STREE7, [VERETT, WA 98201 <br />425-257-SS10. - FAX 425-257-8857 -- www.everettwa.org <br />�-121 �'ver�c�e� w�� <br />PROJEC7ADDRESS <br />Owner <br />7enant <br />ConVactor <br />Mail Add�ess� <br />Mail Address <br />Mail Address <br />�;;'-�1��: �ot�n-e.�ei O`t�_PZ <br />State License Nwnber <br />11L1F)'�Pi� � �`�.iV�YI` t� �ulo�i��'_�n <br />Proposed Use of Building <br />Square Footage (If residential new construction, remodel or addilion) <br />Number of devices (If low voltage) <br />Description of Work to Be �one: � � <br />City <br />City <br />Cily <br />SIJt+M/Zfp <br />Statz(Lip <br />StalelZip <br />Phcne <br />����5`lh��OtilB' <br />'. ��,.IWe'�i� <br />Contract� Pnce of Work <br />�n'� Lc1Yu�oQ..E <br />Contact Person (Plan Review) <br />Phono <br />. FEE <br />CITY OF 6VERETT LOCAL SALES TAX CODE IS 3105 �i -% r�-' <br />� <br />1 he'reby cerL'!y that 1 hove read snd exarnined Uiis application and kno�v the same to be tme and <br />con�cL A/l provislons o(/ews ond orrlinances goveming this type of wodc will be complefed . <br />whether specified I�a�rin or not. The grantinD of a psrmit dces noE presume to give authonty to pERMif� <br />violate orcancel the provislons o(any otherstato orlocallaw regulsSn � o�st�ucti � o�the� E I� v`�— �.� ��-- <br />�edormance uf constiuction: That ! am autlionzad by the owneroflhis ro e�fy to edorm the <br />work to� whicli application is made and 1 compty with the Sfate Contractors Law 1827 RCV✓ and <br />296.200 WAC. � � . . . � . . <br />�..�.hSEo ^ra�.7 . . . <br />1 .. . - . � . . . . . . . . . <br />