Laserfiche WebLink
�.�►�� <br />�� <br />�ECTRICAL PERMIT A��ICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits <br />PROJECT SITE INFORMATION <br />PROJECT ADDRESS: �� ' � �- �� <br />BUILDING AREA (if residential, new construction, remodel, or addition) SF <br />BUILDING TYPE: ❑ SFR-DETACHED SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY -# OF UNITS: ❑ COMMERCIAL <br />USE OF BUILDING: �f I���..,.� ',,,,, � S. <br />CONTACT INFORMATION <br />OWNER NAME: rLL�A ���E TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: sTREEr I � �R�(�'� �� �l � <br />CITY ` 7 � � � STATE ZIP � � <br />OWNER PHONE: �7� � OWNER EMAIL: <br />CONTRACTOR NAME: '�v�Q' -�� � �.� � � � <br />CONTRACTOR ADDRESS: srReer <br />CITY STATE ZIP <br />CONTRACTOR PHONE: ` CONTRACTOR EMAIL: <br />CONTRACTOR LIC. #(REQUIRED): CITY OF EVERETT BUSINESS LIC. #(REQUIRED): ���^� ` <br />PRIMARY CONTACT: ❑ OWNER �CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: � CONTACT PHONE: .► +� j <br />- �� � CONTACT EMAIL: <br />AGREEMENT: T hereby certify that / have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this <br />type of work will be completed whether specified herein or not. The granting of a permit does not presume to give auihority to violate or cancel the provisions of any other state or <br />local law regulating construction or the performance of construction. That I am authorized by the owner of this property to perform the work for which application is made and I <br />comply with the Stafe Contractors Law 18.27 RCW and 296.200 WAC. <br />� <br />��� ' <br />�-.�_ � : <br />Owner/Authorized Agent Signature <br />�--�'?�� � <br />Date <br />City of Everett Official Use Only <br />FEE <br />� ��=� °% <br />PERMIT # <br />E I I� (.�� � 1"l � <br />(Revised 10/12/2015) <br />