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.,,_: s ,:.x .�; ,...- , ..._:. .: � n_ r ^. ^----- •�; „ +,,: .; :,-..., :. r� �' ', �` �. <br />�` .; • <br />CITY OF EVERETT PERMIi SER!/ICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />�oU� ���-�.� (n�cvv� <br />PROJECT ADDRESS <br />�cc�t�" �- �+� <br />Owner <br />� <br />Tenant <br />� <br />Electrical Contractor <br />I�vvlc� <br />Mail <br />�— <br />State License Number (required) <br />��� <br />Proposed Use of Building <br />Mail Address <br />Mail Address <br />�oo� ��cw��w <br />C ity <br />City <br />C ity <br />'J � � <br />Square Footage (If residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />Description of Work to Be Done: <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />�;vYv.��f 1,�Y�- �i ��3 <br />State/Zip i /2S.y �/ ^�� P�r� <br />`�r ��-{ �(D o< <br />State/Zip <br />State/Zip <br />Phone <br />Phone <br />City of Everett Business License Number (required) <br />Contract Price of Work <br />Contact Person/Contact Number/Email <br />I hereby certify that ! have read and examined this application and know the same to be true and <br />correct. AI! provisions of laws and ordinances goveming this type of work will be completed <br />whether specified herein or nof. The granting of a permit does not presume to give authorify to <br />violate or cancel the provisions of any other state orlocal !aw regulating construction or the <br />performance of construction. That I am authorized by the owner of this property to perform ihe <br />work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br />6.200 W C. � <br />������ ������� 5 <br />ign <br />REVISED 08/06/2014 <br />Date <br />FEE <br />� �� <br />�,� <br />PERMIT# <br />E ��o g z-� � <br />