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�L�C�'�IC�/��. ��R�6ii`� �PPL.��A.�IOf� <br /> CITY OF EVERET�" PERMI'�' S�RVICES <br /> 3200 CEDAR STREGT, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —w�vw.everettwa.org <br /> ��cd � iJ « ('e e✓� �a.� . al ?� Z� � <br /> PROJECT ADDRESS <br /> � � <br /> �..�c��, � � �C�� <br /> 05vf1 f tdatlAddress Gty S,a�e/Zip Phone <br /> ��'��� <br /> ..�1T.e,n�ant MailAddress City SIa1elZip Phone <br /> =�"'\�i'Ul���.S `�,, �� Zl�(�— G12iJ— �� � <br /> G�,CQ�R-�C� � Z`� L 3 l C�2S S, �J� Ac-l T ( tiN� S X L��i -- <br /> ElectricalContractor A9ailAddress City Slate2ip Phoce <br /> 5w�c� cv�-� � s � 3s --� Ot�3�5'� <br /> I State License Number(required) City of Everett Business License Numuer(required) <br /> �' / i � U�7 <br /> Proposed Use o(Building Conlract Price of Work <br /> � �c�M c�.,�� <br /> Square Footage (If residential new construclion, remodel or addilion) Conlacl Person/CunWct Numb�r-�il <br /> �O(O— �ILo — 7j�-�� <br /> SU/��L� S �ILL\ C':L �. <br /> IJumber of devices (If iow vollage) <br /> � �a�� ` � <br /> Oescription of Work to Be Done: �L c kk c.�� �u=�k���v/��_ __o�,__c„�t.u°.,�,. 4— <br /> _ + <br /> ( iv��t�,1.��1�� ��J �a.=-,�-��..- — - <br /> F[[ <br /> CITY OF EVER[TT LOCAL SALES TAR CODE IS 3105 y-y�I .�j <br /> T1 <br /> 1 here6y cerfily Oraf I hnve read and examined Uiis applica(ion and know Nie same to be Irue and _ <br /> conoct. All provisions ollmvs and ordinances govr,ming lhis type olworN will6e compleled <br /> �vhe0�erspeci(ed hcrein o�not. Tho gran(ing o/a pe�nif does notpresume to give authority to PERMITik <br /> violate or cancel the pwvisions of any otherstale orlocai law regu!afing consliuclion or Ihe <br /> pe�fo�nance of construction. That 1 am aulh,onzed by fhe owner o((his prope�fy to peAonn the E l�O� ` I q� <br /> :vork lor which applicalion is made and I r.omply�vilh fhe Sfafe Confraclors La�•� 18.27 RCW and <br /> 296.200 WAC. <br /> ___�� � i�" 1 S <br /> igna ure Date <br /> r.cv�ero esvtao�a <br />