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� � <br /> � � � � <br /> I�R„�� 6� �,�I� ���9�1�7� -�� (�[�I����`V ��h�l <br /> C;ITY GF EV�i�E i i �'E�NIi h a�RVlC�r� 140�--l6 3 <br /> 3200 CEDAR STREET, EV[RETT, NlA 98201 � <br /> 425-257-8810 - FAX 425-257-8857 - tv�ntiv.everelt���a.crg 7,.,a j`�(.� <br /> �� YI/�:/��A_!a vr� � I����� <br /> PROJECTADDRESS <br /> �r� M Y �uti� �-�.���� 7z?� �,-P,��. U,,-� �t-s ��r� <br /> Ownef hiailAddress City � Stale/Zip phone <br /> iTo,t,f n�t�i� �/� S% �l ✓ea�e2r� �1�t�rv ,.// (,vA- Gld�ZO� ud'— � <br /> �(enant MailAddies� Cdy Slale2ip phone <br /> �[1VRl�Ca ia�oG��J li 5 LLG <br /> EleclricalConiraclor MailAddress CAy Slale/Zip Phcne <br /> �-� ,�n v��i g23.� �2� = -- <br /> Slale License Numbzr ' CoNrad Price of Worlc <br /> ��� <br /> Praposed Use o(Bullding Conlacl Person (Plan Re�•ierq <br /> Square Foolage(;f residenlial new conslruction, remode�or addition) <br /> Number of devices(Il low vollage) <br /> (� / <br /> Uescriplion ot Work to Oe Done: LL) l�Ir ��iAvt n�./� ���r� ��� �,1A �n <_� <br /> �V�'t�.if ✓�/i ( L �� �/�'�' <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CO�E IS J105 G�D. �� <br /> I hereby ceAil�thaf I have read and examined fhis applicalion and kno�v Ihe same fu 6e true and <br /> correcf. All provisions o(fa�vs and ordinances goveming Ihis(ype o(worlr will be completed <br /> whefherspecilied herein ornoL The granfing of a peimit does not presume�o give au(honty fo p[RM[T# <br /> violaleo�cancellheprovisionsolanyolhe�sfaleorlocal/awregulatingconslrucliono�(he ^ I 1 /D� � ��� <br /> pedormance o(constmcfion. Thaf I am aulhonzed by(he o�vner o(thrs propedy(o pedorm fhe t �� <br /> work Por which applicafion ismade and 1 comply with(he S1afe Confrac(ois Law 1@27 RCW and <br /> 296.200 WAC. <br /> \ it'�\��—�i� <br /> Sionalure Dalc <br />