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Oa � 0 t 3 02 3°p <br />• <br />ELECTRICAL PERMIT APPLICATlON <br />CtTY OF EVERETT PERM(T SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />-025-257•88'iQ - FA.X 425-257-8857 - vrrow.everettv��a.org <br />aqzG ��� �e 9�'�/ <br />p1 <br />� � 3/0-�� � <br />l�� �io ��3 <br />a•:rcr .\1all Aticiess Gty SI3(erZ p Phone <br />Tm an; <br />,., <br />_Irc;ritzl Contra�.er <br />Ltzi :.d�Yca <br />� rr ��4 �05 1 <br />I.tail Ad�ress <br />i ogSCS � � � d� �m <br />Srate L.�ensa PJumber <br />Prcpos9tl USe C' �uildinq <br />cty <br />Ave �E <br />Sq�are P_etage (If resldennal new c::nsW:tion, remodel or aeddlon� <br />Plumber ot Aevicec (If la�v volra;e) <br />Descnpuon af Work fo Pe Done � <br />CITY OP EVBft[TT LOCl1L SALES TAl( CO�E IS 3105 <br />u.y <br />SiTteZio �hc�r <br />�t �5 33�-I 4� S � y� <br />L Q iLe St-e lierzs �r A Q� a5� <br />Slate2�� Phone <br />� ��� �.o <br />Cortract'rFcc cf'.Ncrk <br />Conlacl Perso�� (Plan Revlew) <br />� Aore�y cer7d}� fhaf I havc �eod ond exanuned pns app/ic�fiun and know thc sanre fo be tiue and <br />co�mct Al; pravrsions oflews anC orclmancas qovemrng flns type oI work �vi7l be conioleleA <br />,yhe!r,ersuec�ficd hcmin or not i he gr.�nGng ol a pemuf does nof presumc lo give aufhonry fo <br />viu�ate o�� cancel the pro:-isions of ar,y ofher sfate o� locz! !aw �gWanng conslroUron or tl�e <br />peAaonance o/co^stn¢Oon. Thaf f am auU;or,'zod 6y Ihn pN�ne�OJlhis propcarfy fo perfomi 1he <br />v.ork Ic. wirich appiicaf�on rs made ard ! comU�Y ��•��t� j�'+c SNtc Corf��tfors Law 78.Zi RCLV and <br />?05 200 l.�l+C <br />=n�5: � ., .:� � <br />I'f=f. <br />i�a-�� <br />PE Rh7 Cf � <br />E r3��-0�19 <br />