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ELECTRICAL ���'�IIT ApPLICATIQN <br />CITY OF EVERETT �"-RMIT SERVICES <br />3200 CEDAR STREGT, EVEREI"T, WA 98201 �f �� �� C�7 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />�����9-�yz <br />APPLICATICNS ARE ACC[PTED FkUM 0 AM TO 4 PM <br />�i �,���; _i�•��, � t, 1�,.,.- C����:<-��1 �';1� �� 5<<_,., <br />—�-� � <br />PRUJECT ADDRESS � <br />�<',: _�G,) u J� �- � �` � <br />����.. „�: .� �\- -- >>-\=i_��,. � F_.`c C._'{� �,-�I� ��4�-`'�3 <br />OWnef ` 61ai1 Address Gty SLdeiZip Phone <br />� , �����Lc_ �,. <br />Tenant <br />Electrical Contrar.lor <br />S�ate Lir.ensc Number <br />Proposed U,e ol �uilding <br />r.lail Addiess <br />Idad A:ldress <br />Description of Work lo Oe Done: �� 1.. _ �';. \�. <br />NOTE: WIRING IN NON-DI,NELLINGS IS REQUIRED TO <br />6E IN RACEWAYS, A4C OR AC CA6LE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />Ctly --- --- — Statc.Zip <br />Ci�; S���e2q; <br />Contract Pncr, of Work <br />Conlacl Person (Plan Revicw) <br />FEE <br />I h��mhp r.eihly fhal I ha���� �ot�d rind examumd th�s app6caGon �md 6rias Uie some (o be 6ue and E_ -� C'- �- 1`�', L. <br />C <br />�.nu�ret. All piovisiuiu ollan�s and oidinunccs go��eio�ng fhis fype ol �roik tr�ll be cornple(etl <br />r,hulhcr specilied hercin o� noL The �ranling ol a pcnnd does nof presum ��o give nuthonty fo <br />viol.�fe o� cance/ the p�ovisions ol:iny other sfa;e or local lnw reyulating const��c(ion or (he <br />pe�iarrnance ol cons6ucflon. Thef I am airthorized Gy the o�ti�ner ol thls propertV fo perfurm the <br />,vork lor u-hi�h application is rnaAe ann I comply wRh Ihe Sta(e ConVactors Lau� 18.27 RCIN and <br />296.200 WAC. <br />��^' � <br />. _ _ �_ _ ` <br />._— �_ .'". — 1 � � �---- <br />tiiqn;alurc Oata � <br />Phone <br />Phonc <br />