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������c�,L ����o����.����-�or� <br />ClTY OF EVERETT' PERM17" SERVICES <br />3200 CEDFlR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 —�vww.everettwa.org <br />C 15�6-077 <br />6 - � S—� �-s <br />1 Z Z i,o�u 5 r <br />PROJECTADDRESS <br />{; Ffl4 1'� +i�i� I 'i`I 7 <br />Oc:ner t�tail :�ddress <br />C���:,,,�>v���� G:1r; - <br />; <br />Tenanl hdaii Address <br />� t•�1;,� � <br />Cdy <br />City <br />L��, c, �. �.J � <br />State2ip <br />S�aie�Zlp <br />Phen� <br />Phone <br />� u1.t:l%L:l.:\/ �I.GlL-f1"-li. I�L` i�`3%( 1�6 V—t I°-f�-lNa„i� � `-� �r i �. <br />ul � �A. i�Dtis (�z5)Et�.z�,��. <br />Electncal Coniractor (��aii Address Gty Slate/Zi <br />P Phone <br />i� <br />;,.����t T 3o�c �,-1 �"t. � i y <br />State License Number (required) City of Everet! Business License Number (requireti) <br />n ��. <br />�J F I� i���ti'it: ���J � <br />Proposed Use of Building Conlract Price of Work <br />Square Footage Qf residential new consiruction, remodel or addition) <br />�� <br />Number of devices Qf low vultage) <br />I a i�'.-lN_Li�{11J l�Sc'Ww9•;Ict�F` NwLiN✓ �G:'�"vt <br />Contact Person/Contact NumbedEmail � <br />Description of l4�ork to Be Done. C�S���= 11L/ ���C�j�'y 5•9V i N � ij,c"Y �^ �c.€Tv�f"l�j- [,� ��Grl�`4 � <br />v.i1'Tli 1=r1;a� � I?I1:Jul i-�`c�)j �JG-ihG,�i-� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />; fieieby certi(y fhat ! have iead and exammed this applicafion and knoiv the same to be true and <br />correct. A!I provisions ollaws and ardinances governing fbis type of ivork �vrll be completed <br />r;h,ether specified he�ein o� noL The y�anting o� a peimit does not presume fo give aufhority (o <br />�-iolate or cancel the previsions of any other s(ate or local la�v iegula(ing construction or the <br />performance ol consGu�.tion. That I am aufhorized by the oemer of fhis property (o perlo�m the <br />irerk lor whiG� applicauon is made and I compty ivi(h the Sfate Con�ractors La�,v ]8.27 RClN and <br />2�J6.200 WAC. <br />�V <br />ee:aseot_�ae,zor., _ �l�LC I7? i�%f <br />FEE <br />�� tJ DD <br />t <br />PERMiT# <br />E I�G`�-0�� <br />