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�ECTRICAL PER �T AP�CATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(p) 425-257-88'Ifl ! FAX 425-257-8857 �(E) everett�ps@everetfiwa.gav { www.everettwa.gov/permits <br />� CONTACT 1NfORMA'i1C1N ' <br />NAME: d'd�l��'".� 9'��—'sr <br />MAILING AQDRESS: sraEEr <br />CITY <br />PHONE: `�j ,, c� �,`'� (.c� C�.S <br />1CTOR NAME: � <br />ACTOR ADDRESS: STREET <br />CITY <br />�r�NAr�� r��,r�� o� <br />������ �S�r <br />�/' { -�—�—�+—.___..._ <br />1/ �/",�1 G•rt <br />OWNER EMAIL: �l�"/°'��� <br />%f � <br />STATE <br />STATE <br />C.� <br />CONTRACTOR PHONE: �� U / cvl i� CONTRACTOR EMAIL. t�'��`C`� ���'� r� �u'� ' 4/ <br />CONTRACiOR LIC. #(REGlUtRED): �� L�L, � ! C„� CBTY taF EVERETT BUSINESS LIC. #(REQUfRED): r �. v <br />� V <br />�., :, <br />PRIMARY CQNTACT: ❑ QWNER �QNTRACTOR C7 OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHQNE: ��[J ��j✓� f,�(,� �C <br />' i� r�,,i . '�--,�'s,'i CONTACT EMAIL: ,�}�i ' °►L,j ,� C �`�'t <br />AGREEMENT.� T hereby certify that f have read and examined thrs application and know the same fo be true and carrect. A f provisions of laws and ordinances goveming ihrs <br />fypa of work will be completea' whetherspec'fired herein or noE. The granSng of a pem'+it does not presume to give authorefy to vrolate or eancel ihe pravisions of any ofMer state or <br />loca! iaw regulating eonstruction ar the performance of constructron. That 1 am authorfzsd by the owner af this property ta perform the work for which applieation is made and ! <br />comply with the 5tate Contracfors Lavs 18.27 RC W and 296.?00 WAC. <br />ar <br />OwnerlAuthorized Agen4 <br />� ����-�, � � � <br />t/pLG <br />Crty of Everett O�ctal Use n y <br />FEE <br />� ��� <br />- <br />PERMIT # <br />E o����7i <br />(Revised 10l12/2015} <br />