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E�� 11CA _, P RAWTA ' -s'L_,JJ(3� ` �-� I��,.I. <br /> _J I� .� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br /> PROJECT ADDRESS <br /> t ft W • i7D 13b•;' l 5,-0 E Vtl?,c'TT irkL.. .i <br /> Owner Mail Address City State/Zip Phone <br /> GrZv1I`1i0.JoE'tt.1 64, i:115. <br /> Tenant Mail Address <br /> City State/Zip Phone <br /> '/1A. <br /> Electrical Contractor Mail Address CityState/Zip P Phone <br /> IALC-)b ku E I- 3t;(60 rt-ft:is I I <br /> State License Number(required) City of Everett Business License Number(required) <br /> Proposed Use of Building Contract Price of Work <br /> Tr GVASI�hl TSC-h'WDvtuArt.ST IV i,.)LINV-1Zt:M/1 <br /> Square Footage(If residential new construction, remodel or addition) _ Contact Person/Contact Number/Email <br /> Number of devices (If low voltage) <br /> Description of Work to Be Done: CDS Mg CM:X.4,y SAV i N L ii -f' <vLeyv•1tcp._ L..16-l1 < l <br /> ';?/'l n-r< r-iAr,> i I 1vE i-b)-0 s 3 Ci 17Y <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105An <br /> 5` <br /> I hereby certify that l have read and examined this application and know the same to be true and <br /> correct. All provisions of laws and ordinances governing this type of work will be completed <br /> whether specified herein or not. The granting of a permit does not presume to give authority to PERMIT# <br /> violate or cancel the provisions of any other state or local law regulating construction or the <br /> performance of construction. That I am authorized by the owner of this property to perform the <br /> work for which application is made and/comply with the State Contractors Law 18.27 RCW and I 014 <br /> 296.200 WAC. <br /> 4 471. I j <br /> TilAn: 1/4 N— / %I I 6/ I `J.-- <br /> Signature " i I ) Date ` <br /> REVISED 08/06/2019 t'L L_ !) 1-17.1 <br />