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�ECTRICAL PERMIT A�ICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVEREl-f, WA 98201 <br />(P) 425-257-8810 I FAX 425-257-8857 I(E) everetteps@everettwa.gov I www.everettwa.govlpermits <br />CONTRACT PRICE OF WORK: $ ' <br />NUMBER OF DEVICES (if low volta <br />FIRE ALARM? ❑ YES <br />ASSOCIATED BUILDING PERMIT # <br />DESCRIPTION OF WORK: 1 4 <br />NAME: '�J �\ �� <br />MAILING ADDRESS: s�a <br />CffY <br />ER PHONE: � — ;� '�J.� � <br />CONTRACTOR NAME: �P� <br />CONTRACTOR ADDRESS: <br />NTRACTOR PHO� <br />UTRACTOR LIC. # <br />ELECTRICAL APPLICATION INFORMATION <br />� � 'rJ�� <br />e�: <br />❑ NO <br />� <br />STAEET <br />CITY <br />le): <br />� <br />CANTACT INF01tMA7'ION <br />�I�i Y� �CP�S , TENANT NAME (If C <br />1�170 V a�' Pc� � <br />/ <br />i5 OWNER EMAfL: � <br />'-- ` � <br />� <br />5 ��1 �3� � SE- <br />�o�U�l' CONTRACTOR EMAIL: I�� <br />STATE <br />STATE <br />7�'�'1 .1 �-% <br />OF EVERETT BUSINESS LIC. #(REQUI <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: <br />CONTACT EMAIL: <br />AGREEMENT.- T hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing ihis <br />rype of work will tre completed whether specified herein or not The granting of a permif does not presume to give authority to violate or cancel the provisions of any o�he� state or <br />local law regulating construcfion or the performance of construction_ That I am authorized by the owner of this property to perform the work for which applicaGon is made and l <br />comply with the State Contractors Law i8.27 RCW and 296.200 WAC. <br />/�-�j � / � I��� � j .,� _/� �, e ,� � ��� � City of Everett OHicial Use Onty <br />�V � l �.ic� l.r vl�t/Y <br />FEE <br />��s - a � �v- os� �j � �'�1� � �p� <br />PERMIT # <br />E � �� �� <br />