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�L�CiRICAi� P��MIi APi�L�CA`�i�N <br />CITY OF EVERETT PERMIT S�RVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - wv�nv.everetN✓a.org <br />q �_ � � Ib��, A�c� �����e�- W� <br />PROJECTADDRESS <br />Owner <br />Tenant <br />tdail Address <br />A7ad Address <br />��-�aoHs� �le�-�t�c.�l5c.v;�s ZS <br />E!ectncal Contrac!or WailAddress <br />i��_�e_s iS� QG <br />State License Number (reqwred) <br />� (�es;��e,,�l��� <br />Proposed Use oi Building <br />Square Footage Qf residential new conslruction, remodel or addition) <br />Number of devices (If low voilage) <br />Description of Work to f3c Done: <br />CITY OF EVEREiT LOCAL SALCS TAX CODE IS 3105 <br />�vu� <br />City <br />City <br />—� <br />C;ty <br />iffUi <br />�J <br />State2ip <br />State2ip <br />�ZS -7GQ862� <br />Phone <br />Phonc <br />Phone <br />�41��� <br />City of Eve;ett Business License Number (required) <br />� 7W <br />Con racl Price cf Work <br />L"�as Alo„ o�q�sz�t6hl3 <br />Conlact PcrsoNContact NumbedEmail <br />I hemby cei5/y �Iraf I have read and examincd rhis applicefion and know fhe same !o be fruc and <br />carrrct. All provisinns ollaivs and ordinances governing (his type ol �vortc will be complefeU <br />whetherspccificd hemin ornof. The ,qnnting o/a pennit aocs not piesume to give authonty fo <br />vio/afe or cance! (he piov�sions o/any othersfate oNocal law 2gulating censfruclion orlhe <br />peAomrance o/ constnicfion. That 1 am authorized by the ownero/Ihis prope�fy fo perlomi the <br />tvoik !or �vhich application is made and / compty �vifh (he Sta!e Conliactots Law i8.27 RCW artd <br />296.200 WAC. <br />l � ��� __ _��Z� 15 <br />Signalu�e ------- -- --- -- <br />FELISEDOA2Y.'0f< <br />Fr_e- --, i <br />� 50.°° _�l <br />PERMIT� <br />E �5(� �2p(�� <br />