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EL �iRI�AL PER�II � PL9 A�� �9 <br />�i��r oF Ev�����r �E��o-�s��voc�� <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />, <br />�5�� /�'��S <br />PROJECT ADDRESS <br />Owner <br />Tenant <br />Electri�al Contractor <br />Mail Address <br />Mail Address <br />� �� <br />'c . �•-I C , ,, <br />1 � <br />Mail Address <br />���� � �-:E� ; � �� <br />City <br />City <br />zz�� � � <br />���� � <br />� � �, �oa� <br />Sta1e Li nse Numbe <br />i <br />� S� <br />Proposed Use of Building <br />� y ���� � <br />Square Footage ('ff residential new construction, remodel or addition) <br />Number of devices (If low voltage) <br />Description of Work to Be Done: <br />y�� <br />�Jd. y�'�o� �y3 y� <br />State/Zip Phone <br />State/Zip Phone <br />� �7 i i„� >� �6' �,� �r� <br />State/Zip <br />�� <br />�S�"�o <br />Contract Price of Work <br />Contact Person (Plan Review) <br />r' <br />-� � G��U � �G� l��•��✓ / ��7 C2 /' d <br />Phone <br />FEE �r� <br />� r�t �, r <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 �� � 1�-�'"�� <br />`,` <br />1 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 fhis fype of work will be completed <br />whetherspecified herein ornof. The granfing of a permit does not presume to give authorify to PERMIT# <br />violate or cancel the provisions of any other stafe or local (aw regulating consfruction or ihe ,, // �,, <br />performance of construction. Tl�at ! am authorized by the owner of this property fo perform the E� C�' B`� ��'�� � <br />work for which applicafion is made and I comply with the State Contractors Law 18.27 RCW and � V <br />296.200 WAC. <br />� l , , _ <br />f <br />Signafure <br />