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ELECTR��e4�. ���.��� APP�l��T�ON <br />ci�� o� ������� ������� s���s��� <br />32�0 CEDAR S�-RE�T, -V�R�-�T, �,�IA 98201 <br />425-257-8810 - FAX �25-2�?-88�7 — wrwv�.ev�rettwa.�ov <br />'� � S�- �v e��-�- MC�11 v�l G�� �- I 0`Z l� <br />:= s=��JECT ADDR�SS <br />Owner Nail Address Ciy Siate/Zlp Pnone <br />K.S (�l�-�U �p��V' uz�— <br />�r �n� kuti-� 4�b 5� �er e�-4+ MU11 w�t,� Gv�r���� v� ��c�2��; �-� �4- <br />Tenant Mail Address Ciiy Statz/Zi� Fhone �`� � <br />��i�a�.`� <br />Electrical Contracior °�,1aii Address <br />Siate Licerse 1urr�ber (requir2d) <br />� � I�e �, r <br />; Proposed Use of Bui!ding <br />� Square Footage (If residential new construction. remodel or addition} <br />' Number of devices (If low voltage} <br />Description o` Worh �0 3e Done: _ <br />S�u�,.�✓� On � �;1 ci i <br />� N �/V' U J�� (�� � <br />Ciy <br />SYate/Lin <br />Fhone <br />City of Everett Busir.ess �icense Nur.,:ber (required) <br />Contrac� P; ice of VVor� <br />Contact Person/Centact Number/Email <br />�'Q��� �)QG�«i ���� <br />� ,D�rm ��'- �' UM /1 f�tJ o/ <br />IZ` Y -f-� � �^ �, <br />on � e � c,,,�, � J <br />c.� �� �`e l d c�. �e d <br />'I . <br />i =EE <br />; �€TY OF �VE6�E�T �oc�.� sA��� �,�� coc� �s sz�s �O o � , <br />� <br />'. 1 hereby certrfy that I have read and exam;: �sd rhis �;.,oiication ar,d ,!cncv�� the same tc be true and � ' <br />� correcf. All provisions of laws and ordrr,ar,ces gover; �rng this type of r✓ork wil,' be completed ,, <br />I v�✓hethe� specified herein ornoi. T"ne granting of a p�;mif does nct presum,e tc give authority to pt�r��-�`;-- i <br />� violate or cancel the provisions of any other st2t� or'ocal !aw rerula:ing ^orsrructron c� tne <br />� performance of construcfion. That l am authorizad by ti,e ow.+;er of i,�is pr�p�,�fy to p2riorm the ��(�U �_ O � s , <br />work f r�Nh,ich application is � and I compiy wirh fh2 Stat2 Con'; actors ! a�.n� 1c.27 RCU/ and J <br />i 290. 00 VVAC. <br />' gA�'���� <br />; <br />ture <br />� ,��ns�.,:,s;oa;-�:,,, <br />U3ZB <br />