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ELECTRICAL PERMIT APPLICATIOIV <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 1ldFORMATION <br />OWNER NAME: � � � '��!c �.�.,,� TENANT NAME Qf Commerciat): <br />OWNER MAILING ADDRESS: srReer � .;�i?-- ? � i •. / � /� /� � <br />��N = %� �.- �f-r STATE � �-� Z�P �� . � -� i <br />OWNER PHONE: OWNER EMAIL: <br />CONTRACTOR NAME: i%; � /',,% � � i � C ��' , %i .? ,� <br />CONTRACTOR ADDRESS: srREeT ;� ..'> IS - /•� ���' �/�i i � f ^ <br />.S/% � ll a? � //� �� � (� <br />cirv / �r sTATe ziP � � � <br />CONTRACTOR PHONE: �,��% `,���,� --G� %�� CONTRACTOR EMAIL: r9 �,''r.= ,; .c .L � ,�!�?� �-� � !"e'-'r:� <br />CONTRACTOR LIC. # REQUIRED : � 1 �` 1 <br />( ) 7�,� � �_ ;%� /, CITY OF EVERETT BUSINESS LIC. #(REQUIRED):���-7� �� �' <br />PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: � CONTACT PHONE: �� f' �' (f,j -l%�, /�i <br />�� !�(/E t' , ��C1 / f✓ L, � CONTACT EMAIL: (� ./1L/� ,S �� � �%.Sl,,./ � CC; /.=--, <br />AGREEMENT. T herebvi certifv thaf 1 have read and examined this application and know the same to be t�ue and correct. All provisions of laws and ordinances governing this <br />type of work will be completed whetherspecified herern or nof. The granfing of a permit does not presume to give authority to violate or cancel the provisions of any other state or <br />locaf law regulating construction or the pertormance of construction. That 1 am authorized by the owner of this property to perform the work for which application is made and 1 <br />comply with the State Contractors Law 18.27 RCW and 296.200 W,4C. <br />�� . <br />�� �� <br />OwnerlAuthorize Agent Signature Date <br />City of Everett Official Use Only <br />FEE <br />� � � �1_/ <br />PERMIT # <br />E I (� C� ' 0��� <br />(Revised 10/12/2015J <br />