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To: Page 4 of 4 2015-04-06 14:35:30 PDT 12063683197 From: Service _ <br />S <br />� � � �� � _ � <br />��� �� ����C��� ������ �����'��� <br />3�00 CEQAF� �TRE��', EUERETT, WA 982D1 <br />42�-257-881 t3 - �AX �25-�57-�885? -•, www.everettwa.oeg <br />�PPE.tCAFtQNS �4R� AG�EPTED FRCIM $ �11A' i'C� � PM <br />w <br />� � ! #� ', � <br />PF2Q.f�GT A�I7D12E58 <br />���C� ��1r�F� 853(� EVEi�GREEN'WAY �V'����� g��Q� <br />C?wner Mai� Address <br />�F��� ��YE� ���/i� <br />Gitr/ State!'�'ip <br />����'�t� VIi�9�2�� <br />Ten�nt t�.9�ii Addres5 {;axy <br />����C��, ��� P'.�. �ax �3524� ���f�ie <br />�iectricai Conti�actor Mail Adcfrnss �ity <br />�C.��F��i���BJ� <br />S��,tc Lic.�nse Number <br />����/iEi�C1�4L �U�L��NG <br />�'roposed Use of Buiidin� <br />Stat�.+'Z!p <br />U1/� �� 13� <br />Pl�one <br />�'hvne <br />State/Zip F'hqne <br />1ltl;� �8133 �Q�-368-�2Q1 <br />Gonteact i?rice of Wark <br />BI�L OGD��1 206-5�8-4331 <br />Cantact Persan (Pfen Review} <br />Descri�iiun ot Work to B� �oree: ��T� � � � �V !/ �L�� i✓1 ��r � ���. �(��' i C3�G� <br />CQ�iA�T: �ILL DGi�Ei� 206-5�8-4331 <br />_ � � 50b. �"� <br />� <br />�_ �.._ ,�.... <br />� '�- � �. <br />�.....�.,.. �� �'...�_ _ <br />NU'1'E: W€RING dN �IC�N—L?V3/Et�LINGS IS f2EQUiR�D TO <br />BE l.IV RA�EU'�lAYS, I�I� �F� AC C�BLE. <br />�ITY U� FV�F�E'C'I' i�OC�iL SA�ES TAX Ct3D� IS 3105. <br />! hf�rc�by �erfify that 1 hav� r�ad and examiner� th�s a/�pNc�flUn �nd icnow fhe samc� fo b� true and <br />cvrrer.t. .AU �rvvisions offaws �nd ardinances go.v��ninc� fh�s ty�� oi work iv�ll be cornpleFed <br />�vheUter s�erfier! l�erein or'no�. �he gr��ntin� of a p,errn�t does� no( presume io gi�r� authorrfy fU � <br />v�a(ate orca;ncel tfis pro�isions ofarry ather state prloca!law:r•ec�ulating cor�siruction ar the <br />perfo�m.�nce ot cUnstructron. That l am authoriz�d hy fbe c�wrrer of this properiy (o perform the <br />we>rk.for tivf�ie{� app(ica�t'qn is made an�+! cvrnp(y with fhe State Conlractor� LaUr 78,27 RCVI/anr� <br />�2�t�_,�2CIQ I,N/�C? <br />:' <br />te <br />�EE <br />� �' �C� <br />V <br />I��-�,z� <br />