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!�r': �Ci;`_�U�S500 p 1 <br /> • ` I , • <br /> � _ <br /> -- ---__-- --- --, i - <br /> i <br /> I �L����S��� ��i�aiVid� 9"'ir �i..���� 0�J7�0 <br /> I CiT't( OF �VEF�E�� P�IRIVlI�' S�r�aJ�CES <br /> 3200 CEDAR STREET, EVERETT, WA 9820� <br /> i 425-257-8810 - FAX425-257-8857 - ww�r�.everettwa.org � a�9—I({' I <br /> � �/ �//Z—��� <br /> I I <br /> I <br /> '� j GvU S� _ ����f�� �% /�I�L� u� G� I <br /> PROJECT ADDRESS � <br /> ,�� � / I �j--L' I <br /> /�/` � ��`��� ��G �� I� � �u�C�in y •J <br /> S��te/Zip Pnone <br /> Ow�?t Idail Adtlress I � ' J I <br /> � � <br /> � ' I I <br /> �^�J9,�i7 — ��: �-c I � <br /> �dad AdGress � � C�dy SIa1c�Lp Phane <br /> Tenant I <br /> / � ..�� ) ��� --� <br /> jl���. (i' '�/� '�����lG�� �i`.JSU r���I�(n�i�v '�C!Ai�7l�- ������ ��-, 7/`�;7,J` 1� � <br /> tdail ACC/Css I Gty IalelZ�p Pnan� <br /> EleCtriCal onlractor � i <br /> ' d ✓� ' <br /> � � � � � �� �� � <br /> + %��i�, �u �,� k � I � .� <br /> State L¢ense Numb^r (reqwred) � Gry of Everett 6usiness L�cense Number (requuetl) <br /> � I �7 ) � <br /> � �)7j%/CP'" l� � � ��� � <br /> , aroposed Use of BwicLny , I Contract Pnce of Work <br /> I i�_/%/�/// / C'�%L(. <br /> I�I Square Foo�age(If resWenUai nzw construcGon, remodel or adadion) Contac� PersoniContact Num`� '- <br /> il <br /> I �-' I <br /> tJumt�er of devices(If low vcllaye) j � <br /> � -T' 7 <br /> ���� y?/�„� / �_ • �i�C��l S �_ =Y�Si,�-___�_ <br /> oesu�pt�on o!Work to Be Done. / / <br /> i � , � � � <br /> �; 4-�;.I i; �����v,�rJ� <br /> � � I <br /> i I --- <br /> ; � �te�.� � � <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3�OS I <br /> I he�eby certrlylhaf I have�cad and exarruned(his apphc�f�on a��d kro���I��e sari�e fo he fr�,e a�id - <br /> correc( All prov�sions o1�aws and ordmances yoverning Ihrs type ol work r:Jl bc comp�efr.d <br /> whetlrer specified herem or noL The granling o/a pcim�t does nof presume fu 9rve aumonty fo PERhIIT« / � � <br /> violale or cancel fho prov�sions of a.ay afher slafe or I�cdl law regu�efing construction or(he r- i I <br /> ne�foimance o(consfruclion. That I 2m authorrzed b}i fh�owne�o/th�s property fo peAorm(he � <br /> ��:ork Ior ahich appi�calion�s made nd!comply wdh fhel Sfate Con(ractors La�v 18 27 P,CW and <br /> � 29@200 C � . <br /> f <br /> � � � � �1�� <br /> �„l� ��!' I I ✓�2 �7� <br /> I Signaturr. � I Uaie. —_— .. .., --_ �,.-- — _' . <br /> �'� . I � 4. . � <br /> 4 �� f-•j1 <br /> � � � � �'.� �� � ���� � J � <br /> aEvisED oaD:/:aia —�'—' <br />