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Jan 05 12 0129p Custom Communicalions 253-536-f3456 p 1 <br />• • <br />I <br />� ELECTRICAL f'EF�M <br />; CITY OF EVERETT PERI <br />3200 CEDAR STREET, EVER <br />� 425-257-8810 - FAX 425-257-885; <br />� APpLICATIONS ARE ACCEPTED <br />� <br />PROJECT ADDRE� <br />��l�l � <br />Ovmer V <br />``, <br />Tenant , <br />Mail Address <br />�� <br />0 <br />M�il Addre.: <br />ElectricalCoNractor i - IAo�inddmcs <br />i <br />�o� 3ac� �s� <br />State License Numberj <br />�u�..i.k'��� ; �-Q�1� <br />Proposed Use of Duildjng <br />I <br />i ` ^ , <br />Descnp6on of Work toi6e Done: � W 1`Q.�,-� <br />I <br />NOTE� WIRING �N NON-DWELLINGS IS REOUIRF_D 70 <br />BE IN Rl�C�AYS, MC OR AC CAf3L[. <br />CITY OF EVERETT LOCAL SALES TAX CODE 15 3105 <br />I hemby cortify fhqt ! lr�va road nnd oxomined Ihis application an <br />co�rod. All prpvisrons oflaws ond adinonces govemm,q ll.rs typ� <br />whefherspocdiodheminornol. niegmntingolapenn�(doosnc <br />vrofafaorcanc�4(hn provisionsofanyotherstot�orlor�llaw�cg <br />paformen�o o7consln/dion. Araf !�m nuthcrizod 6y fho o�mcr � <br />work (or wh�dr applicntion is mado and l complv wi7h 1he Sfafo G <br />' APPLICAi14N <br />T SERVICES <br />T, WA 98201 <br />www.everettwa.org � —05 /z <br />M8AMT04PM C������ <br />�,� � �ac3 <br />�� <br />� <br />� � q�� 4s I <br />City I Stutc2ip I P�q E : �- <br />`�.J <br />��'� � � U � � !Y� J � , <br />Ciry <br />SI�iclZip <br />GitY I Slate/Zip <br />l � �c�oc. �v <br />Contrad Price o( Work <br />I -� u�-�? v� � w1a� s <br />Conta� Pcrson (Plan Review) <br />6 f=F� �� -- 'T�'M.� � <br />�ow lhc s. <br />wwk �viU � <br />psumo to <br />� L _ <br />�J <br />no to be frue and <br />� complolod <br />dvc QuBionfy to <br />r.�ion or /hc <br />fo por(arm (fro <br />78.27 RCW ond <br />FEE <br />���•.Gu <br />EI�-oI- o i 5 <br />, �: <br />J� <br />