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� <br />� <br />��...������/��.. ����ii � � r` �i��.��1������i <br />CITY OF EVERETT PERI�li7 S�iRViC�� <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425 �57-8810 - FAX 425-257-8857 - :^n��r�v everelt�va.org <br />SE <br />l�lvtsu-�.����k t.t.�cu� � ��'�� <br />PROJECTADDRESS <br />�'l,n.l,L �t�tS�'-C.�C-k. ��l S t E�9{n� � �l.�Lf.�I� <br />Ov,ner <br />S�U - �►� h..�-�-� <br />Tenant <br />P;ia�.l Address <br />L"a I Address <br />C�ty <br />� il� <br />Cdy <br />�r,��"S-�ah� �.es�-�.�� 1�-�Z "F�IL$-s� i <br />Eledrical ConVactar ��4a�lAddiess <br />�ST� �6`� Q � <br />Stale L�cense Numbe� <br />Praposed Use of Bwid�ng <br />Square Foolage Qt residenlial new construclion, remodel or addition) <br />Numher of devices (Il low vollage) <br />Descriplion of Work lo Be Done: <br />�t-ea-�-' u-tN � <br />CITY OF EV[RETT LOCAL SALES TAX CODE IS 3105 <br />S. <br />cnY <br />����C�) s�s- � <br />StateRio Phcne <br />svtc'l`�/(.U`�- ��"�-�)?4`-F-C; <br />Sla'e2�p <br />t/lUt'r- �4`LS� <br />--, <br />Slate�Z�p <br />G.�V � <br />Conlract Price of 4Vork <br />Conlacl Person (Plan Reviev+) <br />I hereby certi/y fhat I have read and aramined fhis �pplication and know (he same (0 6e 6ue ard <br />ccrrec(. All provisions of la�vs and ordrnances goveming fhis type olwork will be tompfefed <br />nhethe�specdied heicin ornoL 7he granfing o/a permit does not presume (o give aufhority (o <br />violate or cancel fhe provisiens ol any ofher sfafe orlocal la�v regulafing consfruclion or (he <br />peAormance o/conslrUc(ion. Thaf 1 am aufhonzed by fhe owner o! fhis p�opeRy fo pe�form (he <br />ivork lor �vhich apphcafion is made and I comply wdb fh� Sfa(c Confractors Law 1827 RCbV and <br />296. Z00 WAC. <br />���1,� � �- � �- — �l0 � <br />^- S�gnalure ---- ----��-- --Uale <br />---------- �-- <br />Phonc <br />�I-`f-�- �' <br />Phone <br />F[[ <br />� O� <br />PERMIT� <br />EI�{o7-(�3Z <br />