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tl <br />--- -i <br />; <br />�L�C�"RIC�L PE�rVlli APPLlCA�'IC�N ; <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STRGE i, EVERET? V'!A 9o2G i <br />425-257-881 Q - Fr^JC 425-257-Bd57 — �; � �.� ��' -C � ���1` «'2 ��r; .' <br />�r..��� I r,�src�-FePs Gr eve:ratf id1_��pv <br />Cisi�..o7y <br />1 �a -� s <br />i�� /� �ir���: �� '� I <br />PROJECTAGDRCSS� ��� <br />� � ty :�- � �. �� �'7 , � <br />e.�j�:� i^c �i��C �!i•I ,' b�i:a �, � <br />�J:.r',9;--=.3-._._._..__.-..-_-.� _ �!�!iAtldrasc....,_._.-_... _.,.�,-T._.M�_._-:_... Smtc�Zi[; "-^ Fnoce <br />I 4{Wl!vl���il' l•'--•m-�'r ���__T • <br />.-T-.-.-c-_—v.--�.__ <br />� `en9n1 �daiIAJU'C9G <br />Elo�Clc'!p <br />Pho�e <br />i� �+_ r � <br />� ���IiUV.�:�i= `LCi-11��C. ��t 1;'JF i��� �tl'��-�..\.�� In%U �I�'�'i,3 ��IZti�i.L�'i'�C� <br />C <br />ClnGtqcal G7nIryClOf !'d i A:;-rpss �Ly StatelLp Phone <br />I�y' Ll 1 61V�:� <br />' �� �.�i��G '.. ,��'�` �,'i 1 <br />' �!ate Uren;e Number (requ!recj Cily e( Everet; Eusine;c Licen,e Wumher (requuea) � <br />l'J'/!iii'J1��.1Vli �' "V�.� � <br />� Prcaesed Use of Builaing Centract Pr�ce c` YJer�: � <br />Sauare rootu9e !R rPs�,.^.ent�al new conslruchon, remotlel or adtl�tio�) <br />i <br />V�.imCer ct devices Qf Icv: voltage) <br />Tc=wc�.,n,� r,o•iw�.�,.,W:2�.n,..���,.,�...•.,: <br />Conlacl PersoNCanlact PJumberiEmail � <br />Gescripticn ot Work tn Re �ene�. CC.S��'.<T�L� i�"i�i,�> SAV �N � i�:"1'�.�i�.T��o7•,-�- c:3= L 16,-n �4 � <br />•ji;�'n{ F::��� �_, �41:��� ri:•��>j� 7i �lLc.�n I� <br />r-eE I <br />��.ITY OF EVERE'fT LOCAL 5l1LE5 TAX CODE IS 7105 ��� � <br />'Sl / I <br />� . r:•,iby certily Lhat l have rcad antl examrned fAi; �ppl;cahnn arJ know fhe :;anre (o be Vue ind __ ___ .___ <br />_-_uecf All p.ovision; ol /arv; and ordmance; goveming fhis type ol riorr: n.11 be complefed -- - ---- <br />.,,^,ebher spec�6ed herern cr nof. The granting o/ e pemri! does not presumc fo gnz autho�ity to 4'FR��1T1� ` <br />, v�date cr cancel fhe provi5lons ol,;ny o!her s�a(e or local fa�v mgulating con;(iuction or fhe <br />uedermance o/ construc:�on That 1 am authorized by the o�rner ol fhis property fo pertoinr !he E I� I I— D�—� <br />work �or which applicotien is medr antl 1 cemply n�;th Ihe State. Con!raclors La�.v 78 ?7 RCW ar,d <br />295 200 tN4C <br />� �\ i�� �� <br />l, L�,�1 % 1� l. r�-.j!/ <br />Signalure j <br />i� <br />� --._.___._..' r,. LL 7�� (�lil�l I <br />