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11�1di201J 1J:A0 Fa.l' 4'.5J5J80J4 E��ersreen Securit� � 00: <br />• • <br />ELECTRICAL WERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 GEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 —t+nvw.everettwa.org <br />I 1 l D`�1�,�.n �-e�'' A�,-2, —`��u,w� ��-� <br />PROJECT ADDRESS <br />�✓5 0� Sn�tc <br />ovmor <br />Dvs u-� Ch <br />Tananl <br />.- 1''e.QXI <br />Eleclrical Co .ractor <br />A!wl Address <br />n+��i nadross <br />Moil <br />�--v ���.�� � a-�.a <br />Stntc License Number <br />{Y� ��.��.�-'l.�-Sk�_ <br />Proposnd Uso of Bulldlnp • . � <br />Squara Fwtage Qf rosidan!WI new eonstructlon, remoCel or addition) <br />4� <br />Numbcr ot doviccs (If low vollage) <br />Gty <br />t� <br />SIalN210 Phor.e <br />ciry si� 25 • 3 �t $-345�"° <br />���lol �e,l-4 �.�.1� �`d263 <br />Clty <br />oescnption of Work to Be Done: �1 � q I q1' � <br />CIlY OF E'JERETT LOCAL SALES TAX CODE IS 1105 <br />Slale2fp Phono <br />� ��12q.�5 <br />ConUact Prlce ot Wortc <br />_ ��n '^i' � <br />Contntt Person (Plen Review) <br />I hcmby mrtlly (hat f hnvc mad end ereminyd this appllcaflon and know (hc sume fo be hur nnd <br />tortrtl. All provisions ollaws and oidmorrces gaveminr� f6is type of work will Do completed <br />H•huthur spodlied hemin ornoL The p.antinq oIa pyrmit doos nof prosume to givc outhonty fa <br />vlolato or caneel the provisions of any ofhnr sfato orloeol low mgulnKng tonsfrvcNon or t�a <br />pndormance o1 conslructlon. That I am nufhodzed by the ownar pl fhis proporty fo porfomr fho <br />work lor whicA opplrcnfion is made xnd 1 compry wifh tho Sfatv ConfracPors LBw 18.27 RCW nnd <br />REY.SFD3'.�Y/] <br />FEE <br />I�� -3� <br />re�tru <br />E 131 I - 0�3 <br />