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10/19/2015 10:31 FA1 �25 257 8857 EVEREI�' PER�IT SERVIC�S <br />�� ` a .' : �" i, s '� ' "� Z c �' r � :i� a � =�s � :; <br />�`� $ � � b__ d � �-�� a � <br />���Y �� �VER��°T' ����lT ��R�/I��� <br />3200 C�DAR STREET, EV�RETT, WA 98201 <br />425-257-8810 - FAX 425-2�7-8857 — vvw�n�.everettwa.org <br />/,� � `� -' `� �� �J� �. <br />� �� L� <br />!��C}����' AQDRE aS <br />O�r,rner <br />Mail Address <br />Ciiy <br />StatelZip <br />� 003/003 <br />Phone <br />Tenaet'i Mail Address Ci9y State/Zip Pilone <br />� f� �� �!) <br />��c�r ���� �,��-.�r���s<<������ Y�-x 1�'�"� M'1'���,cu�'��I�� 1�R c�?�v h�.3-`�Y�s <br />ElectriCa! Con4ra�tor ��iailAddress Ciry StatefZip Phone <br />C����;'5�.�.��i � �� <br />Sfat� License Nurn'ner (req�ired} <br />� i��� <br />Proocsecl Use or Buiiding <br />re Footage (ir resiciential ne4v consYruc4ion, remodel or addition) <br />Number of devices (tf low volfage) <br />C� ��1 ( u '� <br />Ciiy of Everett Business License Number (required) <br />Contract Price of Wor(: <br />Contaot PersoNContaci N�ombedEmail <br />i <br />Description or Work io Be Done: �'�'1 �`�L, - �� 1�` ��,� �' �� �, �-' r,, �'�� r' � : i� Y1'1 Ci CJl�� <br />,/ <br />^1-" (�� �1.���Eii' LOCAL SiaLES iP,X C�DE i� 3105 <br />l laer�by certity that I have read and examined ihis applicafion and lmow fhe same Po be true and <br />cor�ect`, AI! provisions oflaws and ordinan�es goveming thrs type of work �ril1 b8 complefsrl <br />�.vhefner speci6ed herein or no�. The aranting of a permif does nof presume to give aufhority fo <br />��iolafe or cancei Phe provisions of any otherstate orlacal la�v regulating consirucfion orthe <br />perlo�rnance or`construction. That 1 am authorized by fhe ownerof fhis property to perform the <br />f✓o,�k fior which applicaEion is made and 1 comply with fha State Confractors Law 98.27 P,CW and <br />296.200 WAC. <br />RE'JI SE� 0?JD6/ZO f 4 <br />FEE <br />� � o� �� o0 <br />PERM�lT# <br />E 1�0�4- �(�� <br />