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S <br />�__ . � .. .� � �,, � � �. ,�� { � � �� 1 � �. � -�-- � i� 1 <br />� � .,J � � � I I � <br />���� �� ������� ����I' ���Fl ���� <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everetfwa.org <br />I. 1 U� � �J ��� ��t`'� 5� � <br />- P,ROJECI" ADDRESS <br />�;��c h`�(� �cl� i n�o � ��� ��� . ��� �t1�� t�-�t� ��2�� � 2v - z,C�3 ��� (7�3 <br />Owner Mail Address City State/Zip Phone <br />Tenant <br />Mail Address <br />City <br />State/Zip <br />Phone <br />/��,� �I�� <br />Elecfrical Contfactor Mail Address Cily Stafe/Zip Phone <br />Sfale License Number <br />'Q��T � <br />Proposed Use of Building <br />�`'� �� <br />Square Footage (If residential new construction, remodel or addition) <br />mber of devices (If low voltage) <br />Conlract Price of Worl< <br />Contact Person (Plan Review) <br />Description of Work to 8e Done: �(����f2,t�-(J ���C�'�� i�'L'r'v �Gt�'r(C� <br />d.� t-�' CirG�LI �� ��t�e �. ��`� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />! hereby certify fhat I have read and examined tiris application and know the same to be frue and <br />correct. All provisions of laws and ordinances governing fhis fype of work will be completed <br />whether specified herein or nof. The granting of a permit does not presume to give authority to <br />violate orcancel ihe provisions of any othersfafe orlocal fawregulafing construction orfhe <br />performance of construction. Tl�at I am authorized by fhe owner of this property fo perform the <br />work for which app(ication is made and 1 comply with the State Confractors Law 18.27 RCW and <br />296.200 WAC. �, _ <br />:" � �,�/�'2� <br />' Dafe <br />FEE <br />% � O C� <br />� <br />PERMIT# <br />E��b7- ��� <br />