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<br />LECTRtCAL P'ERMIT APPLICATION
<br />,E GiTY OF EVERETT PERMIT SERVICES
<br />3200 CEDAR STREET, EVERETT, WA 98201
<br />�P} 42 s-257-8810 � FAX �425-267-88�7 �(E} everetteps@everettwa.gov � www.everettwa.govJpermits
<br />� Pi�OJECT StTE iN�ORMATION
<br />P�oa�cTAo�a�ss: �''�=��:.a�� : �� :� �%�;,�'�;,�-�" �` � � ��., ��t.%`�-;�° � �; � ; � �,; . ��
<br />gUlt-C1�NG AREA (if residential, new construction, remodel, or addition} gF _
<br />BUtIDING TXPE: ❑ 5FR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX I.� MULTI-FAMiLY -# OF UNITS:
<br />USE OF BUILDlNG: �`,�. �� �'��,, t ' � �,�� �„ ,�� �._,
<br />OMMERClAL
<br />GONTACT, INFt3RMATtON '
<br />c�w�eR Nanrr�: �'' �,. (..-"� �-�`" � �"` '`� �-�-� � �_ �� �. �, � � ! , « t �1 �
<br />.-- TENANT NAME (IfCommercia{): �,��1. 6;� �,..�' , �„,�� rr�,�
<br />QWNER MAILING ADURESS: srReer ? �;3 � (,,,� (�} !(� ,i� .S,' � �;"`� �-, �,;v
<br />ER PHONE:
<br />crJNTRAGTOR NARAE: �
<br />CONTRACTOR ADDRESS:
<br />CITY
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<br />ZIP 1 �7 I��.f
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<br />CONTRAC74R PHONE: ;,�G�. `G;,�-'I `� - � .SL � `�7' COryTRACTbR EMA1Lc
<br />CONTRACTOR LIC. #(RELIUIRED): �l�'i �,� z. �{�,`�'�� �J �s"" CITY OF EVERETT BUSINESS LlC. #�{REC2ll�REo)c�3 :'j f � � �
<br />PRtMARY CONTACT: ❑ QWNER �1.,,C,ONTRACTC}R � Q7HER {Please Specifyy
<br />CONT{.�CT NANIE. CANTACT PHONE: ���,� —. �'� `� � - ' �7;C��".i-�' �a°°
<br />��' ���� ����.�"'�� �� cQ�tF;acT en�a��.; �,�, ;,� /���,�':�,�'} �-..�° �'. i�;°���j �'... �`�=-
<br />AGfi'E'EMEIVT: 7 hereby certrly that I have read and eeamined thrs application and know+ the same to tre true and co�rect. AI! provision of (aws and orriinances gavernrng thrs
<br />iype of work wit� be completed whether specifred herein or not. The granting of a permit daes nof presume to give aufhority to violate ar cancei the provisrans of any ofher staYe nr
<br />local faw reguteting construcfion or the performance of construcfion. That I am aufhonzed by the owner of this property to perform the wo�k far which applicatron is made and !
<br />compry witA the State Contractors Law 18.27 RCW and 296.200 WRC.
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<br />Owner/Auth,or:zed Agent S�gnature Date
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<br />City of Everetf Officraf Use dnty
<br />FEE � `
<br />T� ���'�/
<br />PERMIT #
<br />E I 0 -1�1 Z
<br />(Revised 10/12/2095)
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