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; <br />� <br />EL�CT��;ICA� PERMIT APPLICATION <br />CITY t�F �1/ER�.TT' P�RMIT SERVii.ES <br />3200 CEDAR STREE�I', EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 –�.+n^nv everett��va org <br />APPLICATIO!'JS ARE ACCEPTED FROM 8 AM TO 4 PM <br />i, <br />� ��(��l ��tt;� � �� � <br />PROJECT ADDRESS <br />i <br />� <br />Tenant <br />' Q�1�°✓'� <br />Glec!ncalCaatracicr <br />I <br />Mad Address <br />Ida�l Add:rss <br />�,�,:; A�are>s <br />iSate License Number <br />; �� i�� ��1� >' r;a�;�;�j: <br />Froposed Use of Bw pipg �� C <br />I �� �`. <br />� Square <br />nec+ <br />� <br />Cescriplion ol V1'ark to �e Done� <br />i <br />i — <br />remodel or r+ddihon) <br />��t��, i, <br />' NOTE: \NIf21NG IN NON-0W[LLINGS IS REQUIRFD TO <br />f3E= IN RACf=WAYS NiC OR AC CA[3LE . <br />Slate!Lp <br />$IBi= lID <br />I <br />PPC'C I <br />cry � -----s�a;e:r,n Prooe �I <br />� �y I <br />Con'ract Pnce of Work I <br />��ti_' =� <br />Contact Person (Plan Revie�v) <br />_�.=-i-t- --� ----.-_ . <br />_�,� 1 `� 1Q G�i{�{ / �%�ri/ �. � <br />I <br />i CITY OF FVERETT LOCAL SALES TAX CODE IS 3105 <br />' I hcreby certJy flrat I h, ve �eud and e rarnTned (hrs application and kno�v fhe samo lo Ge tiue and <br />� coner.f Ali provisious cf /aws and ordinances gavemiry fhis lype o/ �:�ork viill be cornpleled <br />� �ehethcr speci(ied hermn ar noL The granfing o/ a permit does rwt presume lo give aufhonty to <br />� viela(e o� cancel fhe provisions o/. ny olher statC oi M�af latv regulaGng construction orlhe <br />perlomianr,e ol consfnic(ion. �hat I am aufhonzed by ..e or,ne� o/fhis property (o perfom� �he <br />�e�o�t< (onvhich applicafinn is ma 1G ar.d 1 compty wdh the State Confrac(ors Law 1f3.27 RCW and <br />296200 WAC. � <br />i <br />��r����� ��� i�� /� � � -�. � <br />� � C „qda(ure —,1-;7- � Date <br />�; <br />rEE <br />L— <br />��,J�a�- cx73 <br />