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age: 2 07/29/2014 02:03 PM T0:14252578857 <br />FROM:5094570051 <br />s <br />� �� � � � �� � <br />������ ��������������������� <br />32Q0 CEDAR STREEi, EV�RETT, WA 98201 <br />425-Z57-8810 - FAX 425-257-8$57 — www.everettwa.org <br />:� _ C ,�'+ �M �- ..�`y.� t �.� 1-{- � <br />��o.���+T �D{���SS <br />t� °:�"i`1�'�-r� r""/-i' <br />Owner <br />Tenant <br />� F .� <br />, � �. _ , <br />�; '��'�tr '�"� ��.� ._i .� �:.t�'� <br />Mail Address <br />r <br />`� f`��A ".� � �.�.: �._fst: i �``.... <br />Electricai Contractor <br />Maii Address <br />,-� _ <br />.f t� �i � 1� �„ f:�L^ L � <br />Mail Address <br />,J� i f'� � �` �:- �,.3 z=-J�� �;��' % � /� �� . <br />State License Number "'—' —` - <br />Proposed Use of Building <br />5quare Footage (!f residential new consiruction, remadel or addition) <br />Number of devices (If fow volfage <br />r—� � <br />�..: ✓-�! l.:.L � j .I..� <br />City <br />C�ty - <br />�/ ff{`µ��e_.�-� . <br />City <br />��?�T .r! �'f'`-�Y �^: ..:.�r <br />Stats/Zip <br />State/Zip <br />�� .F�,.�l'�9.�`' -'J;;�" � <br />Staie/Zip <br />Contract Price of Work <br />�.d�... <br />�7 '� F ! ��. "' .� �„\� �..� . <br />Phone <br />Phone <br />J <br />„-.i,' f.� : _} / -r , � i <br />C .,i �.�^ ;-f�� 'kJ� <br />Phona <br />Contact Person (Plan Review) <br />Description of Work to Be E7one: /` �•'",°�, ��;3 f� " � ' • t <br />�: �:.. �'° �,.,�'t,_y;` ,r,s°. � /=-,f c.... �,,'�; �� �; _,,' � ` <br />� � ,:, �: $ <br />f..... , ; <br />i'', �'"'x`, <br />CiTY OF Ev�RETT L,oCAL SALES TAX CODE IS 3105 <br />f her�by cert{(y thaf t have read and examined this application and know the same to be true ancl <br />correct. All prcvisions of taws and ordinances goveming thrs type of work will be completed <br />whether specified herein or not. The granting of a permit does no1 pr�surrfe to give authority to <br />violate or cance/ the provisions of any other state ar loca! law �gulafrng constnlctlon or the <br />perfom�ance of construction. That ! am authorized by the ownsr of thrs property to perforrn the <br />worf� for which applicatron is made and ! compty wrth fhe State Contractors Law i8.27 RCW and <br />296.204 WAC. <br />�-: <br />,_, j? ,i, , o <br />Rev�s�o 3rzur�a <br />�EE 0 <br />�� �/ <br />PERMIT# <br />E ��f0� � � 1� <br />