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� � <br /> L� `�����►L �� �°� � ��O�e�`�� ' <br /> CITY OF EVERET'1' PERI�I1' SERi/ICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br /> 2 ��� �lr-���1�� ���e� `� �+-�.. �,�: �� <br /> PROJECT ADDRESS <br /> Ownet' Mail Address City State/Zip Phone <br /> 1�%x /b't IICt=- �.-�%V�-Ld�1 c�l� Z��C;�( ('�,� .��,-< <r�r�`�'�5 I_:v��'��"}-� �it^,�� i <br /> Tenant Mail Address City State/Zip Phone <br /> L�1� �-'l�'C��'.L !�i�G�� �'.'r,'f"I�-�i' L..�- ���,��;1 5�. �� �3 /l1 tl) ��.rc�k; l�`� �'(�C:� � �fC�����i, l�_�C,,Z <br /> Electrical Contractor Maii Address � City State2ip Phone <br /> '�'�` �C�.l'�'(f L L'� �: C.: �L-.. ) �. �"3 `t �j'�f"� <br /> State License Number(required) City of Everett Business License Number(required) <br /> � :���a 7 c�iC"G�-� <br /> Proposed Us`� f Buiiding Contract Price of Work <br /> j o�� �,� ��- � f�ti��F �_���� �5 �,�;,';? yz�,l �l� �� f��l, , c..�z�� <br /> Squar— e Foot ge(If residential new construction, remodel or addition) Contact Person/Contact N mber/Email <br /> Number of devices (If low voltage) <br /> Description of Work to Be Done: � �1�� �% ��ti� Z- � C� c��� '�e����ti '��" � �n.��v�c�-� �rtii a�-��v�<� <br /> � <br /> FEE <br /> ClTY OF EVERETT LOCAL SALES TAX CODE IS 31Q5 ���, �C� <br /> I hereby cerfify that 1 have read and examined this appJication and know the same to be true and � <br /> correct AI(provisions of laws and ordinances goveming this type of work will be completed <br /> whether speci�ed herein or not. The granting of a permit does not presume to give authority to PERMIT# <br /> violate or cancel fhe provisions of any other sfate orlocal law regulating construction or the <br /> performance of construction. That I am authorized by the owner of this property to perform the E ��l O� I O l <br /> work for which application is made and/comply with the Sfate Confractors Law 18.27 RCW and b <br /> 296.200 WAC. <br /> , <br /> ����,�.4ti�(` _l��`.�-rA�!) _ ��,._ j��_�(� <br /> Signature Date ' <br /> REV/SED 08/O6/2014 <br />