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... r..v �.,� : >w..o....�. ,.. � . ��� �o��.i .�.�u..����...> r.o._, o...�.. w. n <br /> • • <br /> I i <br /> , EL��1'C�I��L. P��?IV9ET AP�L����T��P� '� <br /> CIYV �F �V�R�TT' P�RMil7 SER1/lCES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 I <br /> 425•25 i-8610 - FAX 425-257-8857—ww�v everettwa org ' <br /> 0��.� cJ —/ �j j <br /> L i3Oy-/O� i <br /> � �%_ =; !—) �j . c it,� I�L. i <br /> i PROJECT ADDRESS <br /> i J — <br /> ' I 7 �l 1'� 1 �J r�.� <br /> 5;`a�� 7�,1 U � V �c ��,; �` ( (:�,:t��'1 l J L" r 4%Jt LU / � <br /> IOwner nnaa nea�.:oo C�ty SaiemP � Nnone <br /> � � <br /> I <br /> T;nanl L1ad Addiess City State/dp Phone � <br /> �/ ��Z � <br /> L���'�a� ��C C{�( � L `�-`�L � ,�� ��'�^� { � ti G N� ��� � ' >5�� <br /> l� � C � f �;ti:=� yf� �_ �-���.s�r�, i. <br /> �Ip�t icol ContfaclOr MailAd�mss C�ty ;tat�/Z�p Phono <br /> I <br /> i,��'ca� � ' ct `'I S l��� � S.Z� �:, — <br /> S;ate Li nce Number Conlrad Pnr.e o!VJork I <br /> i <br /> Proposed Uco ol Bwlding Cuniacl Person (Plan Revie�v) i <br /> _^��are Footage 111 residen0al new construct�on.remodel or addNonl <br /> I <br /> Numbcr ol devlces(tl low voltageJ I <br /> Description ul Work lo Be Done: ���S' `�I � /�7 �-� ( . �C�L�: � /�1 /�–f:c'�� f�C/r;'l�� � <br /> � •T <br /> I G �rC� ��_�✓�,.;G. C <% <br /> I — - --- <br /> � ---- i <br /> I <br /> i i <br /> �« � � <br /> CITV OF[VEHETT LOCAL SAIES TAX CObB IS 3105 �0�� I <br /> I he�eb}�Ceihty lhat I have m.vd ancY examrned this,pplrcalion and know Ihc some ro be true and <br /> co'recf Alf provlsions o!laws aed ortiinances govemma this type ol work will he complefed � <br /> �.vhelher specifiod ha�ern o�nof Thc gronting oI a pcmii!does nol prresurue to givc atRhORfy 70 PERM�T# I <br /> i violnte or cancel!he piovis�ons o/dny other s�ale or fncal laiv regutaGng consWction or fho � ` �D �q I ( O I <br /> pafonnanco o/conslniclion. Tha(I am aulhon.ed hy N�e ownu�ol thls propeny fo pehorm 7he I `1 I <br /> work lor whicn opphcohvi is mado srW!comply wifn the Stale Contractors La�v 78 27 RCW and <br /> .^9Q2001hAC l <br /> ;f'"�'�c�-- �_ C7/ /c`S// y I <br /> � S�gnature Dale � <br /> I I <br /> � �,eia:rc ,.>:r•� � <br /> `. --___— .___ . . _ —_ _"___ _—__--._—_____-- _—_—_ — <br />