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����������, ����i R � ����������� <br />�I�'�f AF �VER��'�6' �ERIl�i�' ����/w��� <br />3200 CEDAR STREET EVERETT WA 98201 <br />425-257-8810 - FAX 425-257-8857 — wv�.nv.everettwa.org �`7 � �3� I S <br />C i So �--o�I j <br />63l ._��.��- �� <br />PROJECT ADDRESS <br />Owner <br />Tenant <br />Flectrical CoNractor <br />Maii Address <br />tdail Atldress <br />Mail Address <br />" Ci�y <br />City <br />�.AJt- " !_/t <br />Cily <br />`Sc✓r9c�G �7/0!"/�— - <br />State License Num6er (reqwred) <br />/2�5 <br />I'roposed Use o( Building <br />Square F� .iage (I( residential new conslruc�ion, remodel or addilion) <br />Number of devices (If law voltage) <br />StatelLip <br />Statc2ip <br />SIa1cIZip <br />Phone <br />Phonc <br />�ycS/ / <br />Phonc <br />C7 S Z S-s�' --- <br />City of Everetl Dusiness License Num6er (reqwred) <br />/ �rn � <br />Conlrad Price ol Woik <br />��/q,✓ �/zs z.�s �s�� <br />Contact Pcrson/Contact Numbcd[mail <br />/LTSffE[..g}��4'�•,�.L . urn.� <br />Description o( Work l0 13e Done� �� NF�-�- 7-��" C�'l�faE" U�--�—'��'�"� �"`�� -- <br />C_ -u��_C_�c� sv&,—___ u� ._ / �� ��i1��-t.� C �E-'+r ----- — <br />CITY OF GVERETT LOCl1L SALGS TAX CODE IS 7105 <br />� hc�eby certily tltut I have rcad and cx:unined fAis applicrrtion �nd t<now (He sarne fo br. Irue and <br />correcl. All pravisions ollaivs nnd oidinanr.r.s goveminy lBis type olviork will be completed <br />�vhclhr,r spealicd Irerein or nof. (hr, granling oI a pcnnd docs not presumc lo give airthority fo <br />violale or cancr.l Ihe provisions ol any oinr.r �r,re orm�,� i,���+�o9��rdr�,� co��1r��,ono�� or ine <br />perlonnance ol cont;Guc(ion. Thaf I am aulhorized by Ihe ownei ollhis properiy lo pr.dom� thr. <br />tvod< lor which opplicaliun is madc and 1 comply wdh Ihv Statr, Conlnc(ors l. riw iD.27 RCW ��nd <br />29G.200 W/l C. <br />� — — �------- —U�/.3//� — -- ---- <br />Sig �}ilure Dale <br />FEE --- — — — -- <br />��5.�- <br />PIiRMIl�N <br />E �56� -� D°l3 <br />ir[vr,;[nnP�aonpi.� _— —_ __ . __. _. . _ <br />