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���C`TR��AL P�RMI� �►��ILp�A►�'�OII� <br />CITY OF EVERETi PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org (� � a-a"'{ S <br />C �SDb--i63 <br />�S12 �,',�,��f I/C <br />PROJECT ADDRESS <br />Owner <br />Tenant <br />[leclrical CoNractor <br />C i.rC Cr ��� <br />State License Number (req ued) <br />Proposed Use o( Duilding <br />Mail Address <br />Mail Address <br />Mail Address <br />Square I'oolage (I( residential new construc:ion, remodel or addition) <br />Number o( devices Q( low voltage) <br />City <br />C�ry <br />Clry <br />Statc/2ip <br />StalelZip <br />Slale/Lp <br />2y�,: <br />Phone <br />Phone <br />Phonc <br />p 53Sog <br />City ot Everefl E3usiness License Number (required) <br />��Ca�. c•u� <br />Conlract Price of Work <br />�ctC'.U� �/ LS-7%O�' � — <br />Conlact Person/Conlact NumbedEmad <br />Oescrption o( Work lo Oc Uone: (7��1[.�"�� �r�'� r�«( �"�l Pe 7'�Y I/rfit'l �z�� 6� <br />�p �r>G�t �'L SU v� �-e //�jp�� --- - <br />CITY OF EVERETT l.00�L SALES TAX CODE IS 3105 <br />I hr.rr,by cerfily fhaf 1 have read and examinr,d Ihis applica(ion and know fhe same (o be fn�e and <br />co�rr.cl. 111i p�ovisions o/laivs mid ordinances goveming fhis fype oI wodc will be complefed <br />�vhclhcr spealied hr.rcin or noL !he gronling o(a pennif does nof prosumr, (0 9ivc aufhonly lo <br />violate or cancel (he p�ovisions o/ any olher sfale orincal lu�v regulafing consfruction orfhe <br />pedo�mance o( consl�uclion. Thaf 1 am aufhorizr.d by fhe owner o/ Ihis prope�ty fo pedomi Uie <br />ivnrk !or whicb applicalion is made and 1 compty �a�ifh U�e S(ate Contractors Law 18.27 RCW and <br />29G 200 WAC. <br />.. ,,,�,,. ,,:�,� <br />� -22-�� <br />��,� — --- <br />FEE <br />75 oa <br />� <br />PERMII A <br />EI50�-I�� <br />