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• <br />� <br />__ . � . . �.. �.. �., <br />CiT'Y OF EVERETT PERMIT SERViCES <br />3200 CEDAR STR�ET, EV�RETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 � www.everettwa.org <br />_ .��`� C � � I :-���_�� !-� � {�- <br />PROJECT ADDRESS <br />Own <br />1�e�iant <br />'�� `� -'; � <br />Mail Address <br />Mail Address <br />City <br />City <br />V <br />Slate%Lip <br />Staie/Zip <br />_��� -��-����, <br />Phone <br />Phone <br />� ,�- _ ,( .._ �.,�, e I�� �" `� ;' � �� 2 CnU`� <br />�lect�iCal Contractor Maii Address City State/Zip Phone <br />l�:l � � �r �� ��.�c��� � �f� <br />Stafe L.icense Number (required) <br />Proposeci Use of [3uilding <br />Square Footage (If residc;ntial new construction, remodel or addition) <br />Nurnber of devices (If low voltage) <br />� <br />Description of Work to Bo Done: <br />CITY OF EVERETT LOCAL SAL.ES TAX COpE 15 3105 <br />a � E� �� <br />City oi Everett BWsiness License Number (required) <br />� f ����y�, <br />Contrac# Price of Work �� <br />i � �r.t �c" f � �i�(�� `t� Z�ff� � <br />Contact PersoniContact N��mber/Email <br />! hereby certify fhat 1 have read and examinad ihis applir,ation and know the same to be true and <br />correct. R!! provisions of laws and ordinances goverr�ing (his type of work will be completed <br />whether specifred herein or rrot. 7i�e granting of a pernut does nof presume to give authority to <br />viola(e or cancel the provisions of any ofher stato or (oca! !aw regulafrng construcfioil nr the <br />performance of construc(ion. 7'hat 1 am authorired Uy tfie owner of this propeity fo perform fhe <br />worir for which applicafron is irtade and I comply wiUt the State Contracfors Law 98.27 RCW and <br />296.200 WAC. <br />gn�ture <br />REV7SED OfJ/Of✓2U14 <br />.� <br />�� <br />n�r� <br />FEE <br />PErtMzr�r <br />E <br />