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�i��Q.����/��... ������ ����..0�l��� ��� <br />C17Y OF �V�REZ�' �'�RVl�iT ��R!/IC�S <br />3200 C[DAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />�� �(o W c-rmoc�= <br />PROJECT ADDRESS <br />[,5o4-ad5 <br />� -a-g-+ S <br />�o v�-P—�'J �r�ti1 W�(��'M'1-���5 <br />Owner I�IailAddress CAy StatelZip Phone <br />Tenant 67ailACd�ess C:ry S;atelDo Phone <br />Li2`3 - <br />L.1N�'�2—l��L'�=`�- .�?1�Z IC��'S1'S� �'�T� L(fi'r-R$Z�S =�� <br />ElectricalConiraclor ida�lAddress City State2�p Phone <br />�l tii �(� t---Q C� � Q/`J <br />State License Number (required) <br />Proposed Use of f3uilding <br />Square Footage Qf residential new construclion, remodel or additionj <br />Num6er ot devices (fl low vollage) <br />� <br />Cdy of Everett Eiusiness License �umber (required) <br />�7� <br />Contract Price of Work <br />�cZs _ <br />�c � --5��_ <br />Contact Person/Contact Numbed[mail <br />Description o( Work to De Done: c��—�l C� �\ +'�-�� L-' — <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certily that I have rcad and ezamined (his application andlmoiv tAc same to be frue and <br />correct. Afl provisions ollaves and oidinances goveming fhis fype o/��ork will Gc complefed <br />�vhe(herspeulied herein ornoc The granfing ol a pe�md does not presume to give aulhonty fo <br />violafe or cancel lhe provisions o( any other slate or local /a �s regulating cons W ction or fhe <br />performance o/ constmcfiorr. That 1 am authorized bylhe ov;ner ol Lhis property fo pedorm !he <br />a�odc lor �rhich application is made ond ! compty wdh lhe S(ate Contracto�s Law 78.27 RCW and <br />�oF �nn war. <br />FEE - <br />�� 5 �, � <br />PFRMIT!/ <br />EiSo�-�5 <br />