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� c� ic � �� �� ���c��ion� <br />CITY OF EVERETi PERIV�IT SEhi/ICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />�� Z�� �� /zzs ����, <br />, <br />PROJECT ADDRESS <br />� ,� � � (S U �'���� -- <br />Owner <br />Tenant <br />S� l'f <br />Electrical Contractor <br />5. n Z� G'-• �� c'i �� <br />Mail Address <br />State License Number (required) <br />�r� '� � � <br />Proposed Use of Building <br />Mail Address <br />Mail Address <br />I`.,.v z �n �% <br />City <br />�T� <br />Square Footage (If residential new construction, remodel or addition) <br />Z_ <br />Number of devices (If low voltage) <br />Description of Work to Be Done: ��� � C'"�< <�. ���`� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />City <br />City <br />� �� <br />StatelZip <br />State/Zip <br />State/Zip <br />1 � L `� <br />Phone <br />Phone <br />Phone <br />City of Everett Business License Number (required) <br />Contract Price of Work <br />F-�� � i��.�r��«, �r�1-- z�>� -� y�7 <br />Contact Person/Contact Number/Email <br />ct+l�r'� ��y/� /v-r�/ �' � Z. ��r �'�c�r/.� <br />I hereby certify that I have read and examined this application and know the same to be true and <br />correct. All provisions of laws and ordinances goveming this type of work will be completed <br />whefher 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 or loca! law regulating construction or the <br />performance of construction. That I am authorized by the owner of this properfy to perform the <br />work for which application is made and I comply with the State Contractors Law 18.27 RCW and <br />296. 200 WLI C. <br />�—_-- -- - i — � .� � S - <br />Signature Date <br />REVISED 08/06/2014 <br />FEE <br />� .--� � �'.� <br />PERMIT# <br />EI����� ��;'� <br />