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ELECTRICAL PERMIT APPLICATION <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 />OWNER NAME: �� � ��f�NANT NAME If Commerc <br />OWNER MAILING ADDRESS: sTaEer �` --� i <br />ciTv �/�`C1 sTnTe <br />OWNER PHONE: Z, ' � OWNER E IL: , W <br />CONTRACTOR NAME: �j � LL'4'-�, Q <br />CONTRACTOR ADDRESS: srREET �l,l � X I�--.�1 <br />C���� 1►I1►t\�►`1�Tt,-A �►�i'� <br />ZIP <br />CONTRACTOR PHONE: � L �(� "� �, CONTRACTOR EMAIL: � 1� � � <br />CONTRACTOR LIC. # REQUIRED : �V �}C,,;Q D ClTY OF EVERETT BUSINESS U.#(REC2UIREo): �C Z <br />PRIMARY CONTACT: ❑ OWNER �CONTRACTOR ❑ OTHER (Please Speciiy) <br />CONTA�T NAME: CONTACT PHONE: i�� ., '� O`� <br />� � �01�/ � �� � � �/ CONTACT EMAIL: <br />AGREEMENT: T hereby certify thef I have reed and examined ihis applicafion and know the seme to be true and correct. A!1 provis' s of laws end ordinances governing this , <br />fype of work wllJ be completed whether specifled herein or not. The granting of a permif does not presume to give authonry to violate or cancel the provisions o/ any other state o� <br />local law regulating construcfion or the parformance of construction. That I am authorized by the owner of this property to per/orm the work for which application is made and I <br />comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br />� <br />Owner/Authorized Agent <br />� ��y��� <br />Date <br />of Everett Official Use Only <br />IV✓ � <br />1 � O v / <br />PERMIT # <br />E 1�����2� <br />(Revised 10/12/2015) <br />� <br />�'�'�1� <br />