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�.�c� '�r � <br /> C�-�� � � ��--� ������ �� � � <br /> 320Q CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857—un+vw.e�erettv�ra.org <br /> �1� � � �f� P �. ,���f�. <br /> PROJECT ADDRESS <br /> �'L��`��( t% :`j ��i:.s1 j~� <br /> F <br /> Ownef Mail Address City StatelZip Phone <br /> Tenan4 Maii Address City StatelZip Phone <br /> � � �� =,..'; � �'���'1C. ��,�;.'�-'�' a�r`����" �'tN^� ���tf��` ���� �"jq j,)Y� ,��%'r� ��,•°',� �'f:�` �_� <br /> � � r'r <br /> r <br /> Electrir„al Confractor (Uail Address � Cfty S#akelZip�M�������.;v�,Ph�t1�e�,��� <br /> 1 <br /> �� ��� �� �� �;'`?`� `�e � � 3 � � � � <br /> State License Number(required) Cifiy of Everett Business License Number(required} <br /> l-=Ci/'i }�(`• ' :,/�� r/ L' � '"�r t' {� ,,�" _ � �4 .�'1 '" �}C'1 G v <br /> { <br /> Proposed Use of Buildipg ContracT Price of Work <br /> ll=�.y1 �✓i a�`� :;i S� a�: <br /> II <br /> Square Footage (ff residential new construcfion, remodel or addition) Contact Person/Contact NumberlEmail <br /> � '�+'�-t:'� -�l�'"� �.i �' �•'-�L'��C ]��� �� _�� 'n-'A <br /> :�� �tii <br /> Number of devices(If low voltage) <br /> � �' <br /> Description of Work to Be Done: �'���'�`'�'� � �� ��'�"''� ���{ � `��' �' � ��� � �` �'�"� <br /> ��k. �G�� `��' f�V ti�.i.�i �J �-f--1 at� jlYt'y+(f�„.�f' .,�£�'�'�'') � � 4#�+'L G'� �'L 1 f "`' `. �..�t <br /> .� � P <br /> ��,�y�n �L, S �.%r^.,-;,f," !�•,��^�, � •�..v�•� 1%�•;�,1����� {�'? `� �;i I.t i,�T C,���u c%�.�?.,-k`�- <br /> � � <br /> FEE <br /> CiTY OF EVERETT LOCAL SALES TAX Ct➢L E IS 3105 ���`�,�c e� <br /> }h�reby cerCiiy fhat 1 have read and examA�ed tfais app.'icafion and knov✓the same to be�rue and ) <br /> correct. All provisions of laws and ordinances governing this type of work will be completed <br /> whsther specified herein or not. The granting ot a permit cfoes not presume fo give authority ta PERMIT# <br /> viclate or cancel the provisions of any other state or loca!law regulat�ng canstruction or the <br /> >>er�iarmance of construction That!am authorized by the owner of fhis property to perform the � I�I Z���j <br /> work for which applrcation is made an �1 cvmpiy vuith the State Ca�tractors La�v 18.27 RCW and <br /> 29fi.2n0 C. �. <br /> ,,' � 1 � ..� f �- � � � <br /> , ; � -.---- <br /> -' Sig ure Date ' <br /> .REVISF_D 08/05120'4 <br />