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� <br />_ - :. � t �� � s� � � 4i� r' �` ��, � � � <br />_ � ��, <br />CI1"Y OF EVERETT I'ERMIT SERVICES <br />32Q0 CEDAR STREET, EVER�TT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />� � ( Z. ;�l G L C\ ��C � ��? i � v�-%� �n% /� <br />PROJECT ADDRESS <br />-}-e,�n�-� <br />Owner <br />Tenant <br />'�n - �i mtise� �' c� � cn � <br />Elecfrical Confractor <br />S h�� �.S �l �� � � <br />Sfate License Number (requir <br />�i C S� � ��-� � tt, � <br />Proposed Use of Building <br />Mail Address <br />Mail Address <br />Mail Address <br />Square �oofage (If residenfial new construction, remodel or addition) <br />Number of devices (If low voltage) <br />Description of Work to Be Done: �L� <br />CITY OF EVERETi' LOCAL SALES TAX CODE IS 3105 <br />-�S <br />��c-e � �..� <br />City <br />Cify <br />� 1<e� 5��,��1s 1� <br />City <br />StatelZip <br />State/Zip <br />0 <br />�-� � �5�-az�7 <br />Phone <br />Phone I <br />�,S�zjq�U6f3 <br />Phone <br />0 fi � l� G <br />City of Everett Business License Number (required) <br />�� <br />Contracf Price of Work <br />�u,��L< �� ons6� �? S �Z�q UG I`� <br />Contact Person�act i�lumber/Email <br />��� <br />l hereby certify that I have read and examined this application and know the same to be true and <br />correct A// provisions of laws and ordinances goveming 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 <br />vio/ate or cance/ the provisions of any other state orlocal law regulating consiruction or the <br />performance of construction. Thaf 1 am authorized by the owner of fhis property to perform the <br />work for which application is made and l camply with the Stafe Contractors Law 98.27 RCW and <br />296.200 WAC. ,/ <br />. � s ���n !' / � <br />ature <br />REVISED 08/06/2014 <br />-� <br />FEE <br />� <br />��. �` ���,, <br />� � / <br />PERMIT# <br />E���I -���� <br />