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— —� ---- --�--- ------ <br /> ELECTR�CAL P�RIVIIT APPLICATIOf� <br /> C��'Y �DF �VERETT FERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 —www.everettwa.org <br /> Z-ZZ_ �3� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> C��Z_IU <br /> � <br /> cd � � � 1, �J l� v, �� (E�� �e_� �' <br /> � <br /> PROJECT ADDRES <br /> � � Zc� <br /> ���-V���I � � \� � �68� 53'^> �"1 "''�pr� i,J �-P1� � 3� ��D �37 <br /> Owner Maill�dtlruss City SlalelZip Phone <br /> 1L�. ,Q.^i �G, cg�6 � L� � �'�J z/L c� t- �6 �� �— � �`7 <br /> Tenant Mail AdCress ) City Stale/Zip Phone � <br /> > -S .�i-`_C_�C�C'a . �S�$a 4 �`�l`� A�5 iCe-��^`� �,✓ �- �r� �%�.�4� 9 <br /> Electric2lConiractor MailAddress Gily Stale/Zip Phone <br /> � S�L.�'- � � � �g �( ���-D • � � <br /> Stale License Number � Contracl Price of Work <br /> /> <br /> � ` `�j � �'D��-1 �'1 <--1 �1_�--��-- <br /> ��tJ>, �,-�• ,�itn,� _ <br /> Proposed Use o(Building Contact Person (PI2n Review) <br /> N /!. <br /> Syuare 1=ootage (It resi enti�l ne�t�consiruchan, iemodel or addnion) <br /> ���/� <br /> Descriplion of WorY, to Be Done: ,��2p�—� ��—C�}�_"�'� � � — " " � C�=-- <br /> V��-�`,c�e_�oc���—���-�0`'1�R�- E` o+�=-< <<� -- <br /> NOTE WIRING IN NON-0WELLINGS IS RGQUIRL'D i0 FE[ � <br /> C3[ IN RFlCE=WAYS, MC OR AC CABLE . � <br /> 7� D� <br /> CITY OF EVERETT LGCAL SALES TAX GODE fS 3105 <br /> I hereby r.r,rtdy ffu�(I have rcad and examined(Ins nj�plica(ion r�nd lotow tfle same!o be l�ue and � � .�j�� _ ( ���� <br /> correc(. All provfsions ollaws anJ oidinances gcve�mng thrs type ol work wdl ba cornplefed <br /> �vhefhcr specihr,d hcicin or noL Ilw gran6ny ol u ponnd does nol uesumc fo givo authonty fo <br /> violnle or r,anr,al the provicions ol�ny oUier sfa(e orlocaU,na rogu�:hny cons(ruclion or fhe <br /> per(onnancc eI r.onsln�cfion That 1 nnr aulfronzed by fhe a�vnrrol(his prope�ty fo perlonn Ihe <br /> wo�1c lor which applica(ion is made and I r.umply wi(h (hc Sfa(c Contrac(ors Law 18.27 HCW;ind <br /> ase zoo wnc. <br /> _�`�-_-��_�`=,�--�-� ------ a`� � � � � � <br /> �"Siynalure Dale <br /> I . _ . . . . . . . . . . .. . . _ _. _. _ . . —. . _. <br /> —. � <br />