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� 1 � � 1 � � � � .� 2 T � .. e t <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everetlwa.org <br />l���ls� � '������ <br />PROJECT ADDRESS <br />� �� <br />( ��`' C `�� � (}�? G?�9 <br />�1 ��N���i � �_ J �,iC�'iC�; � t' ' � <br />llG- � / n �L / <br />Owner <br />Tenant <br />Contractor <br />License Number (required) <br />Proposed Usc of Duilding <br />Mad Address <br />Mail Addiess <br />Mail Address <br />Square Foolage Qf residential new conshuc�ion, remodel or addition) <br />Number of devices (If low voltage) <br />Desr,ription of Work to [3c Done: <br />�����'� ��If" <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />ay <br />Ciry <br />City <br />�,� j --I 5 <br />�I, -��7--� <br />��J� M��,'� <br />Sta�e/Z�p (,%; <br />/J l <br />StalelZip <br />Slate/Zip <br />C <br />Phone <br />Phone <br />Phonc <br />City of Everell Business License Number (required) <br />Contrad Price oI Work <br />Conlac� Person/Confact NumbedEmail <br />1 hereby cr,rti/y (hat I have rcad and examined this applicalion and know the samc (o be fn�e and <br />r.orrncl. AO provisions ollmvs and ordinances goveming fhis (ype ol wo�k will be wmp/eled <br />whcfhcrspecificd herein or not. Thr, gronting ol a pemiit dnr.s naf presume lo givc aulhority to <br />viola(e or concel Ihc pmvisions ol any ofher slalr. or/ocal law regulafiny construc(ion orUre <br />pe�/onnance ol cunsfruc(ion. Thaf I am aufhorizeJ by fhe oivner o/(his property to perlorrn Ihe <br />wo�k lorwhich applicalinn is nmJe and 1 comply wifh Ihe Sfafe Confractors Lmv 18.27 RCW and <br />296.200 WAC. <br />p �_, <br />�"Uv��'S <br />��rvrseoosnhaoia <br />�_-,� <br />uc��� <br />rE� — <br />�r�0 <br />✓ <br />PERMIT';t <br />E 15��-D0� <br />