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� � <br />� �T' l� I <br />. 3200 CEDAR STREET, EVERETT, WA 98201 <br />425-2�7-88� 0- FAX 425-257-8857 — www.everettwa.gov <br />� � � � (� � � ' �.4 '� , �-� _� � � � �� � � �; �; �� ' �� "'� i--=`` �� <br />Pi�C)J�C1' ,�DDRESS <br />t__... <br />���. c � . � . I�: <br />Owner <br />Fi �z:. r'� � � � 1 �c. <br />Mail Address <br />Tenant <br />�..'�... t,; u � ' , t:_. i' . . . I` .. <br />r' ,1 <br />� r !,,. t:�_ <br />�_ ..�.:_ ��^ i t Cr�.:\ G-.,� .. <br />Electrical Contractar <br />Mail Address <br />r ��.. , h-� <br />�-i)~ � r� <br />Ciry <br />City <br />�'' C`-- �i�, C� t�, ..� _i. -�i.� t <br />Mai1 Address City <br />� , �� � ,�..�_r � , r _ � -i_ - ; <br />� <br />State License Number {required)` <br />posed Use of Bui(ding <br />Square Footage (If residential new construction, remodel or addition) <br />� <br />Number of devices (!f low voitage} <br />�... � r �; <br />.� -� 'f, <br />State/Zip <br />State/Zip <br />Phone <br />Phone <br />{ y?`' � , i' <br />_ j�;=; ;` J'= { i�-C� } f";-1 r_ r;;.-�. <br />State/Zip Phone <br />�-^ � _,��_ � ,, L._. <br />City of Everetf Business License Number (required) <br />�� �,�t ,..,C;: c':' . �":� c: ? <br />Contract Price of Work <br />/.; .. y,;< _ {` , i.: �. _ j r ��:; �t� i <br />Contact P�r on/Contact Number/Email <br />._._... ._. <br />f _. <br />Description of Work to Be Done: �_� _�i -, � ���, t � - ��^, �-' :-�..!� t� :_.�. �� �. ?; ��� s ��a C �:' f 4 � %� ��. <br />i�� <br />4�....... { . . �� � <br />j t <br />�� i , <br />.� <br />�. � !_ ��, • } c �, ; ✓"l %� i, `) '� GJ , '- � t._ k�,, � �. i .-{j f-� �- ! c1 �� � ��� <br />"�, <br />CiTY t3� EVERETi LflC,4L SA�ES TAX CJi1E IS 3�05 <br />! hereby certify that 1 have read and examined thrs application and know the same fo be true and <br />correct. A/l provisions of laws and ordinances gaverning this type of work wi11 be completed <br />wi�efher specified herein or not. The grantrng of a permit does not presume fo give authority to <br />violare or cance/ the provrsians of any other sfate or locat law reguleting construction or fhe <br />performance of construction. That l am authorized by the owner of this property to perform the <br />work for which applrca�ion is made and ! comply �vrth fhe State Contracfors Law 18.27 RCW and <br />296.200 WAC. <br />�i \ ff, � f � f�. <br />' 1 __ <br />n <br />P.EVISED 08/O6i2074 <br />FEE <br />� I 1.��. o �� <br />PERMIT# <br />I./ V C� f V�l.�� � <br />