Laserfiche WebLink
--- � <br /> �f���`��G�,�,� �����`� ��[���(��'17,���� <br /> �I�'� �F EV�f���'�' �F�MI�' ��9�`�9��� <br /> 3200 CEDAR STREET, EVERETT, WA 98201 ��-�l -1 S ,/ <br /> 425-257-8810 - FAX 425-257-8857 -www.everettwa.org � ;s��- ?J6� <br /> � � � � �� r�v- ,,.�� � ��e ��c �� �^ �-r w � G/ <br /> 4 <br /> PROJECT ADDRESS <br /> / ,t/f ` ,��� - 3iv - <br /> 'e.� � !n � �J�') / / P✓'!i' i r// �U' 2 C. I l �Gl v' �C (JJy � �oZ O � <br /> Owner MailAddress City � StatelZip Phone <br /> S � ln'� � <br /> Tenanl � Mall Adtlress Ciry StatdZip Phone <br /> �' /���e��-,�;� �D,3o .� 9S� �/,h��,,� Gr�/� .�o� - � >o - <br /> 9���� 8sa�d <br /> ElectricalContractor MailAddress City State2�p �hone <br /> � / �L r / ..� CHGTSE ���7/3 <br /> '"( � ( S �I e�/�-i�� D s� % o� �' <br /> State License Number(required) Cily o(Eve etl Dusiness License Number(required) <br /> ��V (J a' _ <br /> �"1 � C iil Gr �r du.>r� <br /> Proposed U o uildiny Contract Price of Work <br /> _ � '7`_ ��.- � �i' P U'— <br /> Square Footage(If residential new conslruclion, remodel or addition) Contacl Person/Contact Numbei/Email <br /> G� e�- Cv- ecJ� � Co�+� ea,S� <br /> l�. ��- <br /> Number of devices(If low vollage) <br /> Descriplion of Work lo l3e Done: O �%c" ��"� U ��� �^ �"'�� �-��r�C ��'� S <br /> ) <br /> o�_b_��-_Su� � �. - �-�� �e--s�- <br /> • FEE —-- -- <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 5105 / .,� J� <br /> /he�eby certi(y fhat I Itave rearl and exornined fhis applica(ion and lvio�v Ihr, samr, fo br. Gur. unJ _ U/ _ _.. _ <br /> correcl. All provisions o/laws and ordinonees gaveming fhis type ol wod<<wdl Le comple(ed ---- <br /> whefherspecilied hem.in or noL Ihe granfing of a penni!docs nof presumc fo 9ive aulhonty fo PERMITN <br /> violafe or cancel lhe provisians ol any ofher sfafe orlocal law regulafin9 consfnicfion or Uie r ��O �_ �/ � <br /> perlomrance ol r.onsfruction. 7'hat I am au0ionzed by fhe ov;nerol this propedy fo pedonn fhr. C f0 <br /> work lor whrth applrcafion is made and I comply wifh Ihc State Con6ar.(ors Law 18.27 RCW and __ <br /> 29G.200 WAC <br /> �//�'t� "'—i__ ��, � �/� .��� IS //� � <br /> Signilure Oalc <br /> I Idv�:JnntlJa,;n�q ' � <br />