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ELECTRIC�4L F'ERMIT APPLICATION <br />CITY OF EVERETT F�ERMIT SERVICES <br />^ RE W 2 <br />�� � <br />PROJECT ADDRESS <br />� <br />Owner <br />Tenanl <br />�/lw,�, � <br />� , <br />Electrical Contra <br />l��u� � yi��i�� <br />State License Number <br />Proposed Use of 13uilrling <br />3�00 (,EDAR STREET, EVE TT, A 98 01 �` s` f <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org �j <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 pM C 13D 6—�Z� <br />; S� /v��/!! �' l <br />/0%3-� �������� ��� <br />PAail Address City <br />Ma�l �ddress <br />Mail Address <br />Jc, <br />Syuare f uotaye Qf residential new conslruclion, remodel or addition) <br />Descriplion of Work to Be Done: <br />NOTL: WIRING IN NON-DWLLLINGS IS REQUIRED TO <br />!3E IN RACEWAYS, MC OR AC CABLE . <br />City <br />StatelZip <br />Slate2ip <br />Phone <br />Phune <br />�(,ta zs�-(vY/f <br />City ' SlatelZip Phonc <br />�1Y---�./�' — <br />Coniract Price of Work <br />Contact Person (Plan Revievi) <br />CITY Of EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hcreby ceRily Iha(1 have rcad and examrned this applicalinn anU know Ihe same fo Gc (r�ie and <br />correcl. All provisions o//.��vs and ordinances yaverning IOis (ype o/work will be conipletn_d <br />whethc� spr,ci�ed herein ornot. ]7m gran(iny o( a pr,rmd does not resume to give authority to <br />vinlafe or cancal lhr. provisions o/ any u(hei sla(o orlocalla�v reyuPtiny conslrur.lion or (he <br />perlonnance o/consfruclion. (hat I am aulhorired 6y Ihe o�vner ol fhis �operty (o per7onn U�e <br />v;o�N lor �vhic;� applir,a(ion is nredr. nnd I comply �vilh fbe Stafe Con(�acPrs Law 18.17 RCW and <br />296.200 WAC. <br />_ ��" � �3 <br />- --��- �� <br />Si9nature - — - - - Dalc <br />FEF. <br />5b-ti0 <br />C i3v�-v� <br />