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- --- ---------� -- - ---- � <br />�L�G�'RICAL P�RiVil�' ���i���l�►�"��N <br />�I'TY OF EVEREI'T PERMIT SERV�CES <br />3200 CEUAR STRE[T, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-25�-8857 - www.everetiwa.org <br />5s I z �������r <br />PROJECT ADDRESS <br />�31Z 1i <br />� `��$ � <br />�. iSo7�� <br />' -OZ55�}- <br />OwnCf� MailAddress City Slatc/Zip Phonc <br />�Tenant MadAddress City StatelZip �/ZS- f'honc <br />t �U(oI_ <br />�'�� -Z3 i- <br />�Yl�� �rcl �b�iZS °l� PL S� �s.kc.�t�ts.�__ W{ 9'ts?54S �' _ <br />iiuv__e.c1�L�c. <br />Elechical Contrac�or Mail llddress Ciry Slate2ip Phone <br />I1.�k-lou��t Szc�Ca <br />Sfate License Number (required) <br />Proposed Use of Building <br />Squaie Footage (If resideMial nev� conslruction, remodel or addition) <br />� Number of devices (II low vollage) <br />��a � �� <br />Cdy ol Everett Busmess License Number (required) <br />Conlracl Pnce oi Work <br />Contact PersonlConlact NumbedEmail <br />IDe;crip�ion nf Work lo !ie �one �C��. 120 Je�- Zo /��Lvyt� -40 �_�,�_. Xz LS1�.Le-�,4_�1 Y�_LeJ1c �S . <br />i 1V. Ca Y -- _ �,�tv:�y.� _-�=16,¢� — -- ----� ----- -- ---- --- � --. ._ <br />e— <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br />I hcieAy r.crh/y fhal I frave read and examined fhis applicaGon and Imow fhc same fo bc true nnd <br />r.o�rer,L �II provisrons ollaws and oidinancr.s go:•enung fhis type ol �vo�k wJl be comp/efed <br />mhe(her specdicd hwr.in ornnL Tfir, g�anfing o/ a permit dor.s nof pm.sume fn give auUtonty fn <br />violafe or canr.el (he p�ovisions o/ any ofhr.r sfafr. orlocal law rr.gulafing conslruction o� fhe <br />pr,rfnmiance ol construcfion. Thaf I am aufhorited 6y fhe o�vner o! (his property (o pr.rlonn fhe <br />wmk !or �vhir.h applicalion is made and I r.ompty wdlr fhe Sfafe Confracfors Law 18.27 RCW and <br />196.200 W/1 C. <br />c� _`_ r�C--�-�1"�� - <br />Signa�6rc <br />iN.�,r.�nn=,pi.qnu <br />�=g=�S <br />Datc <br />F[E -- — - <br />5 0�° <br />PERMITfl <br />E �50�- �3�5 <br />0 <br />