Laserfiche WebLink
- – <br /> -�— -- -- – <br /> --- ------�- – _ i <br /> i __ <br /> - --- <br /> ; ELECTR�CAI� �ERMOT �PIPL��CA�ION ' <br /> j CITY OF EVERETT PERMIT SERVICES ,I <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> i 425-257-5810 - FAX 425-257-8857 - wwe+.everethva.org i <br /> � <br /> �3 �G � v 1-I�0�-, A V�2 <br /> � PROJECT ADDRESS I, <br /> i <br /> � Pc�.� �-i-��-, e ,n=b� S� � I <br /> O�vner P.1ail Addrzss Cdy StatelZip Phone <br /> I <br /> I Tenanl ;'aaAtldr ;s Ci'y State;Z�p Phone ' <br /> , 3 0 �.�,�v,s�o�A� � le �kr , c� <br /> ' 3a �s r� a�s� �.;�� W�fl �i�aao I �� �.q a� - ��137 <br /> � State/Lp Pnane I <br /> i Electr�.calConlracto� L1a�'Address ��N <br /> I 3 c� f c�1 � o � �6 � � G- . � s"� �. 9 '� <br /> S;ate License Number(reqmree) Cily of Everett 8usiness License Numter(required) <br /> Re s � d�.�a ��.` — �-� 5 C� � <br /> i P�oposed Use of Ouitding Contratl Price of Work <br /> 'I ��, ���le,�, �1as 4a3���3�� <br /> i <br /> Square Pootage (If residenlial nee+conslruction, remodel or addAion) Contact Person/Con ct NumberlEmail I <br /> � � <br /> �. ?lumbcr o(devices(II Iow vollage) ��, <br /> nI D �i,.�'V' I' � � 'I�O IZG� � S � 1 �'1LO �'''�� � <br /> I Description of Work lo Be Done: .�R T�IO�G�___ —_�-- I <br /> i v� � �. s — I <br /> � <br /> I FEE <br /> i <br /> ICITY OF EVERETT LOCAL SALES TAX CODE IS 3705 � s O� <br /> � i <br /> 1 hereby certily(hat I have read and examined fbis applicafion and kno�v fhc same fo be frue and i <br /> correcf. All provisions ollmas and ordinances goveming(his fype o!�vod<<vill be compfefed <br /> �vhethcrspecilied herein ornoL The g�anting of a pemiit does not presume to give aulhority to PERMIT# i <br /> violafe or cancel the provisions ol any ofher s(afe orlocalla�v regulaling consfrucfion orfhe C ���� _ � �� <br /> peAormance oI r.onstroction. That 1 am aufhorized Gy the o�tner o!Ihis property(o peAorm the L I <br /> �ro�k Ior uhich applicalion,is made and I cornply v�ilh fhe State Confractors Lari i8.7.7 RCW and <br /> 296.200 WAC � <br /> 1 '/��jj�" !�� � q �O� 5 <br /> Signaturc Dale � <br /> Fn:;eoosvc:ow ____ __- .-__ -- <br />