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; <br />� 1t� ���`�`7 <br />ECTRICAL PERMIT APPLICATION <br />CITY OF EVER�77 PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />{P) 425-257-8810 � FAX 425-257-8857 J(E) everett�ps@everettwa.gov � www.everettwa.gov/permits <br />GONTACT INFORMATION <br />OWNER NAME: � ' TENANT NAME (If Commercial : /V <br />OWNER MAILING ADDRES . srR�er �,L ���) / 1 L��l /�LL7i <br />crtv <br />OWNER PHONE: '7�� '���(�� �- �-1' 4� �� IOWNER EMAIL: <br />CQNTRACTaR NAME: f <br />CaNTRACTaR ADDR6SS: <br />� <br />CONTRACTOR PHONE:w <br />STREET <br />GTY <br />�� �(' /Lfs �' I � � / CONTRACTOR EMAIL: <br />srnr� !�r d ziP '"./?��,�� <br />�� /]� <br />STA'fE IF�M'1 ZIP Jly-��l�f C <br />CaNTRACTOR LIC. #(REQUIREp), � G�f"� l'�1 �- [� '! CITY OF �VERETT BUSINESS LIC. #(REDUIRED�: � `�� �� <br />_._ _ . _. _ _ <br />PRIMARY CONTACT; ❑ OWNER �CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CQNTACT PHONE: ' � _. �`7 — � I `-�j' <br />� �r GU ►z�V 1 1 CONTACT EMAiL: � <br />AGREEM : T hereby cenify that 1 have read and examined ihis appHcatlon and know the same to be t ue and correct. At! provisions of iaws and ordinan overning this <br />lypa of work will be completed whefher speci/ied he�in or not. The grenting of a parmit does not presume to glve authoiity to violate or cancel the provisions of any other state or <br />loca! !aw regulafing construclion or the performance of constructlon. Thaf ! am authorized by the owner of this prope�ty to perlorm the xrork for which application is made and I <br />comply wrth the Siate Contrectors Law 98.27 RCW and 288.200 WAC. <br />�wnerlAuthorized Agent Slgnature � j — Date <br />City af Everett Official Use Only <br />FEE <br />;�S a � <br />PERMIT # <br />E � �O� � � �� <br />(Revised 10/12/2015j <br />