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09f22;'2016 08:41
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<br />PF�OJ�C7 ADDRESS:
<br />BUiLDING AR�A (if reslden
<br />BUILDlNG TYPE: L7 SFR-[
<br />U5E oF �UILDING: �
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<br />�. EL�CTRICAL PERMIT ApPLICA`C[ON
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<br />�j- C!l`Y OF EVER�T7 PERMl7 S�RViCES
<br />� 3200 CEDAR STREET, EV�R�7T, WA 98201
<br />B1� � FAX 425-267-88�7 �(�} everetteps@everet4wa.gov j www.everet�inra.gov/permits
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<br />OW►V�R PH�N�: 50
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<br />CONTRACTOR PHONE: CoNTRACTOR �MAII.:
<br />CONTRACTOR LIC. #(FtEqU1RE�}: /S./� � CITY OF EVERETT BUSINESS LlC. #(REqWR��)��
<br />�PRIMARY CON�AC7: C] Q�rVN�R l� CONTRACTOR 07HER (please Specify)
<br />C�NTACT NAME: r; CONTACT PHON�: �,��� �,Z
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<br />AGR��M�NT.• T herebycertify thai�l have read antl axaminetl tnls applrcatioq and knowthe same ta be true and cw�ect All provls/ans orlaws and ordlnances �7ovemtne tnrs
<br />tyFB of work wf!! be camplatad whBf, er spac�ad hereln or noL 7he grartting of a permit dees not pr�,sume ta give autharity to vlo(ate or cancel the provlslons ol any otner stsre o�
<br />loc�i law regulat�ng conatructron or; ��e performance ol constructlon, That / am authorlred ey the awner of this property to perform the wo�k fvr which appliaation is made and 1
<br />comply with tha Stafa Contractors L�w 18.27 RCW and 296,20Q WAC,
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<br />�wnor/ or�zed Ag nt Signa �ero Date (Revised 10/1212015)
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