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�Li��i�ti��►�. ��I�i�li I l A,�PLY�A,`i'��I� <br />CIiY OF EVERETi P�RM17 SER!(ICES <br />3200 CEDAR STREEI', EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8657 — w�+nv.everettwa.org <br />_ � o� ���v�o�la�n fl�-e. ���,ve,#�, �=► �i�2c� <br />PROJECT.4DORESS <br />G;mer <br />Tenant <br />[Icctricai Contrac,or <br />,y�� � Sf. � FSLc q i� 1 <br />Stale License Nurr.bcr (required) <br />I �P51 c1��1� i M <br />I Proposed Use of Building <br />� <br />Mail Address <br />A1all Address <br />Niail Address <br />Square Footage Qf r�sidential new construction, remodel or addi�ion) <br />Numbe�evices (II low votlage) <br />Ocscription o( Work to �e Done: <br />� �. \ � �' •1� <br />CITY OF EVER[TT LOCAL SALES TAX CODE IS 3705 <br />City <br />c�y <br />ity <br />S iso9- aoy <br />9 -�. �-� 5 <br />Sla;c/Zip <br />State2�p <br />�J—L <br />State?ip <br />Phonc <br />Phone <br />Phone <br />City of [veretl "cusiness License Number (required) <br />� I `104� 00 <br />Contract Price a( Work <br />_ 0. � it 3'I•8y6�--- <br />C tacl Person; oNact Numbef��mail <br />�u���ro�,L .�.ie�g�� � . c�-r� <br />1 hereby cc�ti/y (hal 1 havc mad and c.ramined (his ipplicafion and kno�v Ihc sarne fo be (nie �nd <br />canecf. All provisions o7la�vs �nd oidinancr,s govemrng (his type nl�ro�k nill6e compleled <br />�vhelherspeci�ed hcrcin ornof. The gr:in(ing o(a pem�d docs nof presume fo give authonty (o <br />violate or cancel thr, provisions o/any other s(afe oNocal /aw re�ulafinr� consfniction orfhe <br />podom�,�nce ol conslruclion. lhat I am authanzed 6y fhe owner n((his properly fo peAornr fhe <br />�vork /or nhich application is rnade and I canpty wifh Ihe Sla(e Contr.+clors La�v 1827 RCW and <br />Fc.�s=a o=_:r✓1a�a <br />FEE <br />��� �0 <br />PERMifJt <br />E 150°l - 2a-�' <br />