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0"o/�G/�C,13 06:22 36G,7901Z6 <br />rorrrreLsc:: ___.._.._.. _r;c =z-as =.00�. roo, <br />�LECTRICAL F'ERMIT A�'PLNC�4`�ION <br />C(TY OF EVERETT PERMI7 SERViCES <br />3200 CEDAR STREE�I , EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br />C� 7% � �L���II��� l,l/� <br />PROJECT ADDRESS <br />�dail Address <br />(yz.5) �s9- o8c7� <br />•�1��.�'2Z7, °� <br />State/Zip Phone <br />i <br />�����.�.����� ��� <br />Tenant ' Mail Addre55 . City StatefZip Phor.e <br />(G�'� �a`�9-C�cll� <br />M_ <br />Contractor � � Ma�fAddres, <br />��P1PF'Pi'iUU �Z <br />State Li nse Number <br />Propose�i Use, o B i d ng <br />Square Footage (If residential new consWcfion, remodel or �ddition) <br />Number of devices (If low voltage) <br />Description of Work to Be �one: <br />CITY OF EVERETI' LOCAI. SALES TAX CODE IS 3105 <br />Sta:elLip � Phone <br />`7��,Z� <br />Contract Piic2 of Work <br />�i�/� I.'-IUVI�. <br />Contact Person (Plan Review) <br />I hereby cedify that I have read and examined this application and know the seme to be frue and <br />conecL All prov;sions oflaws and o�dinances goveming this type o( �vork will be completed <br />vihetherspacified herein ornot. The yren[inc� of a pemut does not presume to give authortty to <br />violate orcancel the p�ovisions o/any otherstafe orlocal la�vre�ulatin.q consduction orlhe <br />psAoirnance ot const�uction. That I am authorizod,by fhe o�vnoro(this property to perform Ure. <br />wurk !or which applicstion is rrrade and l comply �viih tho Stato Contractors Law 18.27 A.CW and <br />^aa onn war. � . � . <br />R�N51J S:+'79 <br />FEE <br />2-� � C� <br />PERMiTn <br />� l�G�— j5 % <br />