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� • <br /> — —I <br /> ELECTRo(�AL P�RIVIIT �►F'PLBCA�9C91� i <br /> �ITY Oi� EVERETT PERMIT SERVICES <br /> 320G CEDAR STREEI', EVERETT, �VA 98201 <br /> 425-257-E'�810 - FAX 425-257-8857 - ti��n'+w everettwa org 5 _�a_�y <br /> �, iuos �� '�7 � <br /> - � y��, ST. <br /> N�OJECT ADDRESS �a� S �� (.t�.,(f�(� <br /> / / �µi <br /> � I..�t � p,e��;es !.L gaK/'���hb� 1!l,h o:S D � <br /> N�- ��—�--- 5latelT.�p Phune <br /> Owner tJiaJ Atldress �'�1' <br /> C�I StalelZ�p Phone <br /> Tenan� t.1a�l Address Y <br /> y��� ;T�' ' q�Z��' Yy3�' J,� � <br /> (��� (�sf ��ec�:�a( Se���.eS 3��7 t�-e.�e �. �t <br /> f_ledncal Coniractor <br /> V,ta�lAddress Citq Siate/Lp Phone <br /> I <br /> �,.>eS-E-tC r ��� �� _�� <br /> Conhad Pnce oI VJork <br /> Siale L�cense Number <br /> Conlae�Person (Plan Reviee�) <br /> Proposed Use of[3udding <br /> Square Footage pf residenlial new construction, remodel or addilion) <br /> Nwnber ol dewces(If lov+vollage) <br /> i s�-A(( e� -� � �� �eN�c-e oQ � ,�„�� ����`� <br /> C i�� <br /> Uescription ol Work to 0e Oone: ✓1 _ f --f— <br /> C✓cS 5�u�r7�-��'-- `—'a`=��-----( 1�e.51Z-- _ – <br /> F[E <br /> CITY OF EVERETT LOCAL SALES TAX COO[ IS 3105 ��. —rj o <br /> I herehy ceAify fhaf r have read and examined lhis applicafion and know fhe same fo be Inie and <br /> cer�ecl. All provisions ollavis anJ ordinances goveming fh�s type o!vro�k will be compleled <br /> �vpether specilied herein or not. The granfmg o/a permil does nof pre�ume to give aulhonty to PERMITlt <br /> violale or cancel rhe�:rovisons o(any other sfafe or/ocal la�^�regulafing conslruclion orthe r / , /O�D�I <br /> performance o/constn.clion. That 1 am�ulhonzed by;he o�roner o(fl.is properiy to pedorm Ihe <br /> c �-r <br /> work/or�vhich appLcation is made and 1 compry with fhe Sta(e Conhacfors La�v 1B.27 RCW and <br /> 29G 200 — <br /> ���- � �(Z��`� <br /> Signature Dale <br />