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�LEGTRIrAL PERMIT APPLICATION <br /> CITY OF E'VERETT PERMIT SERVICES 5 _S-1� <br /> 3200 CEL.4R STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857-www.everethva.org � �Ip�Q a 7 <br /> APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM <br /> l3oZ Ncw ,'l�T <br /> PROJECT ADDRESS <br /> 5���5�(3`, �•'lui.� <br /> � � O � l�r� ,�7� �. vT �820 / `/ZS�32-�163j <br /> Owner Mait Address Clty Stalerzip Phane <br /> 1.l e,u e - <br /> Tenant Mail F�ddress City State/Ztp Phone <br /> lJ� l�r <br /> Electdcal Contractor Mail Address Clty Stale/Lp Phone <br /> _ � � QC)C� <br /> State Lfcense Number Coniracl Price of Work <br /> � OVv�.✓�'�C_r C�-�-�C. . <br /> Proposed Use of Bullding Contact Person (Plan Revfew) <br /> Descripllon of Work to Bo Dane: �._) ��'�eC�S <br /> NOTE: WIRING IN NON-DWELLINGS IS REQUIRED TO FEE <br /> BE IN RACEWAYS, MC OR AC CABLE. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hero6y ceAily fhat 1 havo read and examined this applicafion and know the same fo be frue end � I �j— (�2� <br /> correct All provlsions o(laws and ordinances goveming this fype oI work wlll be completed <br /> �rhefher specified herein or noL The granfing o/a pemut doas not presume fo g(ve eufhonty to <br /> violafeorcancelflte provisionso/anyotf�erstateorlocallawregu/afingconsfrucflonorthe <br /> per/onnance o/construcfion. Thaf!am authorized by the ownor ol this property fo peAortn the <br /> work!or which applicafion is made ond I comply with the Sfafe Contractors Law 18.27 RCW and <br /> 296.20o WAC. <br /> � �' /�"__ — J� _ � —� � <br /> � <br /> �Signatuk Date <br /> ✓ <br />