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� F-- ,--� � � .� � ► � � � ;� �; t -� ��� � � P e � /� -� i �; �. � <br />� � � ; , •; <br />�5��� �1-' �i/ ��� 1 � ���1�l�� �������J <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />I 3 Z� (�� � ke.r �v�- . Ev�c�-�-� �=(,��01 <br />PROJECT ADDRESS <br />�-i�JC� i;��E't���„l��,fi'�/ �3Z0 �iv,��ker �Ivci �v�-'�,E <br />Owner Mail Address City <br />Tenant <br />Mail Address <br />Electrical Contractor S(�' v'•. cc%S Mail Address <br />�['��,���A�sqS�a� <br />State License Number (required) <br />S �C'��� ��T CJ `ci,Ci �i <br />Proposed �Use of uilding <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 />City <br />City <br />� <br />State/Zip <br />�7 ` L --3 <br />Phone <br />Phone <br />Phone <br />���-16� <br />City of Everett Business License Number (required) <br />�� �' ��1 <br />Contract Price of Work <br />1 � , ca5 � ��,�s�� /�4� s -z3�� � vti C� <br />Contact PersonlContact umber/Email <br />! hereby certify that 1 have read and examined this application and know the same to be true and <br />cor�ect. All 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 />violate or cancel the provisions of any other state orlocal law regulating construction or the <br />performance of construcfion. 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 <br />296.200 WAC. ,, <br />re <br />REVISED 08/O6/2094 <br />5 <br />FEE <br />� �p�, �� <br />PERMIT# <br />E I� D�l - I �G <br />