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— � <br /> �i����'����� ���d�B� �,«''��0�,�`�'��[� <br /> I �o�� �F �v���r� ����o� ���va��� <br /> 3200 CEDAR STREET, EVEP.ETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 -www.everettv�a.org � _D�y S <br /> , Cls� d -�a� <br /> i <br /> - t--- " ��?2P.�' (/VY'� <br /> � <br /> PROJECT ADDRESS <br /> �r,n-.o�.,�l� �Q._. �OG�,°I 4�1�-�n� W`�/1 ��V�rn�� l�__ <br /> Ov✓ner MailAddress City�� State2ip Phone <br /> �a,�e/� � , ( �—�I/p Q-�'t9-�Jv1 w�'�� �V�'� �� <br /> Tenant Mail Address City State/Zip Phone <br /> r <br /> ,�,� ,,.r �� .�� � ,� �� �.»o I��n ���� (�� ��r�`� <br /> ElectncalContractor MailAddress City StatMZip Phone <br /> �'��C'/l� � �1`1-� I�T' 0�('J � I � <br /> State License Number(required) Ci�y of Everett�usiness License Number(required) <br /> 6�b :o. <br /> S'��t� <br /> Proposed Use of Bu' ing Conhac Price of Work <br /> �Q-Y�^' �� �3 �� 3 i�o <br /> Square Footage Qf;esidential new construction, remodel or addilion) ContacrPersoNContact NumbedEmail <br /> Number of devices(Ii low vollage) <br /> � � <br /> Descripfion of Work to 6e Done: <br /> _.�� �'—�� ✓d� .� <br /> oJ��ul�.� S1I1-� -��'�—� <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 ,� („� j <br /> L�/ <br /> I hereby'cc�ti/y fhat 1 havc iead and exarnined Ihi:;applir.a(ion�nd Irnow Ihe same to bc hue a,�d _.____ <br /> conecL All pruvisions of laws and ordinances governiny(his type oI work wi/i be completed ----- <br /> whefherspecilied hc�eirt ornoL The g�anling o/a permit does nol p�esurnr. fo give authority(o P[RMITJ/ <br /> viola�e or cdncel the provisians o)��ny ofhr,rs(ale or local law regula(ing conshuclion or Ihe r <br /> perlamtance o(wnsbuclion. Tiiat I am au(honzr.d by Uie own^�ol this prnpe�'y to pe�form the C ' SO � — D��j <br /> work lor which applicalion is madr. �nd 1 comply with Ihe S(atc Contrar.(ors L�w 1827 RCV✓and � <br /> 296.200 WAC. <br /> �� � �/"� "" — �} — � <br /> Signalu . , Dale � <br /> r+rvrsr n onmci�o ia <br />