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ro �..a.+ z or z eo�+.ou.o> i n no.i n �c�...r� .uun�av.�...n r-,�,.., o�..�e wv..0 <br /> —."– r'_' - .. . • . . • _ . . . , • <br /> EL�C`TRtCA� PERMBI' �PP�.BC�T'10(V <br /> GBT'Y C.�F �V��f�TT PERfllIBT SERVI�E� <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-II810 - FAX 425-257-8857—www.everettwa.org <br /> _ 3 —.0 --i�c <br /> _ . _ -. �iva3��i <br /> 1��-.5 G�nnr� �JPna.+P - �vP�P+�� W�. �`i5`�oJ, <br /> PROJECT ADDRESS <br /> R;, Ic G�lo�k 1o2s (' .la e ,N Evc��P��- w/+. 9$zal <br /> OWn2f Mail Addmss City Slale2ip Phone <br /> Tenant Mail Address City SlilefZip Phone <br /> (�v � � Glv��r'G PO Qo�r �� (rr �P �wll (.J/� �1R2S2 �36o)�};S'r?-O�n4 <br /> EI dicalContractor MallAtltlress Ciry State2ip Phone <br /> WY.4TTEz94� PD �`�50 �`—' <br /> State License Number ' Conlract Pdce of Work <br /> �pa�P WY�. 1- �- <br /> Proposed Use of fiuitding . Contact Person (Plan Review) <br /> Square Footage{If residential new consirunion, remotlal pr adtlition) <br /> Number ot tlevices pf low voltage) <br /> Description of Nlork to�e Done: ��-�� r o o w� �^ p vr n[A P�• <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 �71�U� <br /> ( ./ <br /> 1 heiuby certily thnf!havo reud and oxaminod fhis applicalion and know fAe same io 6e lrue nnd <br /> cuner.( All p�ovisions o/lows�nd ortlinnncos yovemin�this fypa o/work will he conrplefed <br /> whoU�errpociled horoin ornot Tha gmntin�o/o pormi!docs not prosumn fo givo nufhonty fo PERMITk <br /> viofale orcancel the provisions ol any olhorstnte orlocal lew requlahng consfruchon orfhe D/^� / <br /> pr.�7ortnanr.o ol construction. That 1 am aulbonzr.d Ay tho ownoro/flris prnporty fo perlorm Iho � (4 O 3— lJ�O <br /> work lor which applicafion is medo anU 1 comply wifh Uro Stete Confncfors Law 18.27 RCW and _ 1 <br /> 296.200 WAC. <br /> ��� � . �ou�e f�"_ ���/2�{ <br /> Sigw!urc Oate <br /> . . REVISLU L1N1] � ' . <br />