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.ECTRICAL F'ERMIT A LICATION <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 />CONTACT INFORMATION <br />OWNER NAME: � ^ r' TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: srReeT ,';l i <br />i .1 <br />CITY ' STATE - ZIP - � � <br />OWNER PHONE: OWNER EMAIL: <br />CONTRACTOR NAME: /'�;,,p � <br />CONTRACTOR ADDRESS: srReer <br />CITY STATE ZIP <br />CONTRACTOR PHONE: CONTRACTOR EMAIL: <br />CONTRACTOR LIC. #(REQUIRED): CITY OF EVERETT BUSINESS LIC. #(REQUIRED): <br />_ _ _ _ <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: <br />CONTACT EMAIL: <br />AGREEMENT: T hereby certify ihat 1 have read and examined this application and know the same fo be true and correct. All provisions of laws and ordinances governing ihis <br />type of work will be completed whether specified herein or not. The granting of a permit does not presume to give authority fo violate or cancel the provisions of any other state or <br />local law regulating construction or the performance of construction. That l am authorized by the owne� of this property to perform the work for which application is made and I <br />comply with the State Contractors Law 98.27 RCW and 296.200 WAC. <br />Owner/Authorized Agent Signature <br />-,�..� <br />Date <br />City of Everett Official Use Only <br />FEE <br />���/ <br />PERMIT # <br />E � � c- �- a� <br />(Revised 10/12/2015) <br />