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�LEC• <br />TRICAL PERMIT APF'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 I <br />OWNER NAME: <br />OWNER MAILING ADDRESS <br />OWNER PHONE: <br />CONTRACTOR NAME: �.- <br />CONTRACTOR ADDRESS: <br />CONTRACTOR PHONE: �S <br />STREET r �C O � <br />cirr � (i eJR.� <br />�� �Q�� <br />STREET ��(� <br />cirv � <br />.. i�l - �� <br />TENANT NAME (If Commercial <br />OWNER EMAIL: <br />� � G�' o � <br />',. IIV� c4 �l �i <br />\ �.(W' <br />CONTRACTOR EMAIL: <br />STATE <br />�� e, _ <br />STATE �.�.J �,. <br />1Zi <br />ZIP <br />ZIP <br />CONTRACTOR LIC. #(REQUIRED): .�. �(L.u,j �(,� "r' � � CITY OF EVERETT BUSINESS LIC. #(REQ D):O 1 <br />PRIMARY CONTACT: ❑ OWNER ONTRACTOR ❑ OTHER (Please Specify) ----- - <br />CONTACT NAME: CONTACT PHONE: Zrj'3 �. Z Z � G{ 2 v� <br />�� �^ , � CONTACT EMAIL: <br />c3 �t A►�! 1= To � Q ��ait c.�J (,�S c N�o (a �� . C,�I•a <br />AGREEMENT. T hereby certify ihat I have read and examined this applicatron and know the same to be true and correct. A!! provisions of laws and ordinances governing this <br />type of work will be completed whether specified herein or nof. The g�anting of a permit does not presume to give authority to violate or cancel the provisions of any other state or <br />local law regulating construciion or the performance of construction. That I am authorized by fhe owner of this property to perform the work for which applrcation is made and l <br />comply with fhe State Contracfors Law 18.27 RCW and 296.200 WAC. <br />__ -����; � �� <br />,, � �:, �� <br />Date <br />City of Everett Official Use Only <br />FEE <br />� � �_ <br />PERMIT# <br />E �c���l — ��c S <br />(Revised 10/12/2015) <br />