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�L��i�IfG�L ��RN91`� ���L���4`�'I�N <br />CIiY OF EVERE'P � PERMIi S�RVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org � _ �--/S <br />��IO F�Ne��s� �v� <br />PROJECT ADDRESS <br />Otvner <br />Tenant <br />Electrical Contraclor <br />Mail Address <br />Mail Address <br />��n / SCY �I f. �� <br />Mail Address <br />60 3 U `� 6�i/ <br />Slate License Number (required) <br />Re s,�la•✓f'�o � hP �a � <br />Proposed Use of Building <br />Square Foolage (If residentiai new construction, remadel or addilion) <br />Number oi devices (If lo�v voitage) <br />i <br />Oescription of Work to De Done: eY v l � <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />Cily <br />City <br />� IS�a''. � �� <br />360 3oS / oc <br />StatelZip Phonc <br />Slate2ip Phone <br />'T�/'Qr /l� �h0"OH.C4 9�a40 y�s397� <br />City Stale2ip �� I � �Phonc <br />� ���y� <br />City of Everett Business I_icense Number (required) <br />'��y00 ° � _ <br />C ntract Price of Work <br />Jnfeo%Pxl �.enlz <br />Cor3act PersonlConlact Number/Email <br />. <br />rC4i t <br />1 herehy cer(i/y Ihaf ! have read and exnmined Ihis applicalion and know:r�e same (o be tn�e and <br />conect. All provisions o/laws and ordinances goveming fhi,s ly,ue ol work will be r.ornplefed <br />whefher speci�ed hercin or not !hc gronting of a pennif does nof presumc (o give aufhorily fo <br />vialafe orcancel lhe p�ovis�^ns o/any olher stafe orloca! lav� regulalinr� consfrucfion orthe <br />peAonnance o/ constmction. Thaf 1 am aulliorized by fhe ownerollhis property lo perlorm Ihe <br />�vork lor which applicalion is made and I comply v�ilh Ihc Stafc Contractors Lmv 18.27 RCW �nd <br />2�s.2oo wnc. <br />i+r. vrscn oamcnora <br />FEE <br />�r 15,�°i <br />P[RMIT�I <br />E15a8�Zo3 <br />