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r <br />03/1G/201� 09:05 3504740125 <br />DONNELSON ELECTRIC INC #�586 P.U01 /UG1 <br />���������� ������ ����������� <br />���� �� � Y ���� i ������ ��� V ���� <br />- 32c�C C�DAR ST�Z�ET, EVEFZETT, WA 982G'� <br />425-257-88 i 0 - FAX 425-257-8857 — wvvw.ever�itv✓a.gov <br />� �� ��� ��� � � � <br />PROJECT dR.DDRESS <br />��.'�T-a'ii <br />ienant <br />Naii Address <br />Mait Addr�ss <br />ContraCtoT Mail Addfess <br />�; �rl 1'� � ��i fl �t �t_i�2-- <br />State L�cense Num�er (required) <br />•�t �7,�. _ . <br />Pronosed Use of �uifdirtg <br />Sq�are Footar�e (If residen;ia! r.ew construcf�on, remodel or addition) <br />Number or d�vices (!f low voltage) <br />Description of Work to 6e Done: <br />CITY OF E1/ERETT �O�A� 5�iLES TAX C�9E fS 3105 <br />S4ate/Zip <br />Siate/Zip <br />State.2ip <br />Phone <br />Phone <br />�I2�- 35�-C��� <br />Pho^e <br />City of Evere�# Business License Number (required) <br />�=,--� �� ,,; ` . � <br />Cor:tract Price of Wor4c <br />�ktil_L �/.��vl,� _'�e. �Z>-' ���f��''/�$ <br />Contact Persor./Corotact �lumber/Email <br />f hereby certify fhat I have read and examined fhis a,�plication and know the s2me fo be frue ano <br />�rrect. A!I provis�ons oflativs and ordina»ces governing thrs ty,oe of work wifl be completed <br />tvhether speci��c! herein ornof. The grantrng of a permrf does »ot p�esume :o give author;fy to <br />viol�fe or cancel the provisions of any otr�er sfafe �r loce! law regu(atrng eonstructivri or fhe <br />performance of constructron. Thaf I am authorized by the vwner of t,his proper;y to perform the <br />wo�k for which appliearion is m.ade anr� 1 comply wifh the State Contraetors La�v 15.27 RCW and <br />236.200 WAC. <br />REv�sEo osiverzo�a <br />FEE <br />. , , <br />, .- . . <br />�ERMIT# <br />I E: _ Y .'� �� � , - <br />