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�`;i�_ �;i�`'� Ik:�l��i--u�,ii, y���;f���'ll ��1��6.����'��I'a(���i <br />��t�'`�' �� s��i�6�F�'a ����li �ERi/l�:�� <br />3200 C�DAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-5857 — �.vww.everetlwa.org <br />�—�'O� <br />C o 9��--t� �� <br />ti�PPLICATIOIdS ARE ACCEPTED FRONi 8 AM TO 4 PNi - DEBIT 2: CREDIY CARDS ARE iJOT ACCEPTED <br />'j10�� N•;�;�esc�� I�c� F.vt.�14 wA Rxz��3 <br />PROJECI'ADDRESS <br />Owner <br />Tenanl <br />Electrical Conlractor <br />���Nnvc�.�SSk� <br />Slate Licenso Numher <br />�jus Sic� <br />Proposed Use of Buildinc� <br />71U'0 �iar�i< <br />Mail Address <br />Mail Address <br />P.O.Qor <br />Mail Address <br />Ciry <br />City <br />StatelZip <br />SlalelZip <br />State2lp <br />9'too. �.% <br />Contract Price of Work <br />Cleai�� Gwld� <br />Contact Person (Plan Review) <br />.� �c 't sta�,�„t T�� <br />Descnption of Work to Bo Dono: nCV�aIIaEra o� SuS ��.P � r�i�'" i <br />Utt�trero��•cQ SPWice..� � brakc4� C�rc4iS . <br />NOTE: EIRN RAC WAYS MC OR ACICAB QUIRED TO <br />CITY OF EVERETT LOCAL SALES TA:: CODE IS 3105 <br />I hereby certily that I have read and examined fhis application and know the same to be frue and <br />correct. Afl prov�sions ollaws and ordinances �ovominq Ih�s fype of work �vill be completed <br />uvhether specdied berein or noL The granhng o( a perrnd daes not resume to give aulhonty fo <br />violate or cancel the provisions o(any other state or local law reguPtiny construchon or the <br />peAomiance of construction. That I am authorized by the owner of fhis propeMy to pedorm fhe <br />work /or which applicalion is made and I comply wrth the Slate Confracfors Law 18.27 RCW and <br />296.2J0 WAC. <br />� G2�� ' — b ^U�I <br />Signature Dale <br />FEE <br />Phone <br />Phone <br />Phone <br />�y�b� -oz.y <br />